title: Functional Outcomes and Physical Impairments in Pediatric Critical Care Survivors: A Scoping Review.
abstract: Although more children are surviving critical illness, little is known about long-term physical impairment. This scoping review aims to critically appraise existing literature on functional outcome measurement tools, prevalence, and risk factors for physical impairments in pediatric critical care survivors.
  
  
  
  PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature, using a combination of MeSH terms and keywords (critical illness, intensive care, and functional outcomes/status).
  
  
  
  All human studies reporting functional outcomes in children 0-18 years old admitted to the PICU. Non-English language, adult and preterm infant studies were excluded.
  
  
  
  Three global assessment tools and eight multidimensional measures were used to measure functional outcome in pediatric survivors of critical illness. Rates of acquired functional impairment in a general pediatric intensive care cohort ranged from 10% to 36% at discharge and 10% to 13% after more than 2 years. Risk factors for acquired functional impairment include illness severity, the presence of organ dysfunction, length of ICU stay, and younger age. There is some evidence that physical impairment may be more severe and persistent than psychosocial components.
  
  
  
  Functional impairment may be persistent in pediatric survivors of critical care. Unfortunately, studies varied largely in measurement timing and tools used. The lack of differentiation between impairment in different functional domains limited the generalizability of data. Further studies using a combination of standardized measures at various time points of the disease process can help establish more comprehensive rates of physical impairment.
authors.affiliation: 1Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 2Department of Nutrition and Dietetics, KK Women's and Children's Hospital, Singapore, Singapore. 3Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore. 4Office of Clinical Sciences, Duke-NUS School of Medicine, Singapore, Singapore. 5Clinical Nutrition Research Centre, A*STAR-NUHS, Centre for Translational Medicine, Singapore, Singapore. 6Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore. 7Centre for Human Health and Performance, University College London, London, United Kingdom. 8Institute of Sport, Exercise and Health, University College Hospitals London, London, United Kingdom. 9Division of Critical Care, University College Hospitals London, London, United Kingdom. 10Division of Respiratory and Critical Care, National University Hospital, Singapore, Singapore.
authors.forename: Chengsi
authors.initials: C
authors.lastname: Ong
authors.forename: Jan Hau
authors.initials: JH
authors.lastname: Lee
authors.forename: Melvin K S
authors.initials: MK
authors.lastname: Leow
authors.forename: Zudin A
authors.initials: ZA
authors.lastname: Puthucheary
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D020127:Recovery of Function; D017741:Survivors / Q000706:statistics & numerical data*; D016896:Treatment Outcome