title: Long-Term Function After Pediatric Critical Illness: Results From the Survivor Outcomes Study.
abstract: OBJECTIVE
  Knowledge of the long-term outcomes of survivors of pediatric critical illness is sparse but important. The aim of this study was to evaluate morbidity and mortality 6 months and 3 years after hospital discharge.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Urban, inner city, academic PICU.
  
  
  METHODS
  Consecutive patients admitted to the PICU from June 2012 to August 2012.
  
  
  METHODS
  None.
  
  
  RESULTS
  We collected descriptive and demographic information and functional status assessments at baseline, admission, hospital discharge, 6 months and 3 years following discharge. Functional status was measured with the Functional Status Scale. New morbidity was defined as a change in Functional Status Scale score of greater than or equal to 3. Postdischarge assessments utilized scripted telephone surveys. Of 303 consecutive PICU patients, 253 were eligible and 129 parents consented. Follow-up outcomes were obtained for 77 patients (59.7%) at 6 months and 70 of these patients (54.2%) at 3 years. Both mortality and morbidity increased after discharge. Cumulative mortality increased from 3.9% (n = 3) at discharge to 7.8% (n = 6) at 6 months (p = 0.08) and 10.4% (n = 8) at 3 years (p = 0.03). New morbidity increased cumulatively from 5.2% (n = 4) at discharge to 6.5% (n = 5) at 6 months (p = 0.65) and 10.4% (n = 8) at 3 years (p = 0.16). Almost as many children demonstrated worsening of their functional status or died (38%) as children who survived without a change in functional status (44%). Less than 10% of children exhibited functional gains over time. Long-term functional outcome was associated with PICU variables including the need for invasive therapies and indicators of severity of illness such as use of mechanical ventilation, ventilator days, use of vasoactive medications, and PICU length of stay. The combined poor outcomes of new morbidity and mortality increased cumulatively from 9.1% (n = 7) at discharge to 14.3% (n = 11) at 6 months (p = 0.16) and 20.8% (n = 16) by 3 years (p = 0.01).
  
  
  CONCLUSIONS
  Mortality and new morbidity appear to substantially increase after discharge. Critical illness is associated with a sustained impact on survival and functional status.
authors.affiliation: 1Department of Pediatrics, The University of Chicago, Chicago, IL. 2Department of Pediatrics, Children's National Medical Center, Washington, DC. 3Pritzker School of Medicine, The University of Chicago, Chicago, IL.
authors.forename: Neethi P
authors.initials: NP
authors.lastname: Pinto
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Rhinesmith
authors.forename: Tae Yeon
authors.initials: TY
authors.lastname: Kim
authors.forename: Peter H
authors.initials: PH
authors.lastname: Ladner
authors.forename: Murray M
authors.initials: MM
authors.lastname: Pollack
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D017741:Survivors