Skip to main content

Advertisement

SpringerLink
Log in

The Association Between Functional Status and Health-Related Quality of Life Following Discharge from the Pediatric Intensive Care Unit

  • Original work
  • Published:
Neurocritical Care Aims and scope Submit manuscript

An Invited Commentary to this article was published on 20 July 2021

Abstract

Background

Despite one third of children with acquired brain injury (ABI) experiencing new functional impairments following critical care admission, there is limited research investigating the impact of new functional impairments on overall health-related quality of life (HRQOL) or among important HRQOL domains. We aimed to investigate the association between new functional impairments, measured by the Functional Status Scale (FSS), and HRQOL in pediatric patients with ABI after critical care.

Methods

We conducted a secondary analysis of a prospective observational study of 275 children aged 2 months to 18 years with ABI. The primary exposure evaluated was change in FSS from baseline at hospital discharge, categorized per prior work (no change, 1–2 point increase, and ≥ 3 point increase). The primary outcome was overall HRQOL 6 months after hospital discharge, measured by the Pediatric Quality of Life Inventory (PedsQL) total score. Secondary outcomes were PedsQL domain scores. PedsQL total and domain scores were transformed into age-standardized z scores for analyses. Multiple linear regression models evaluated the association between FSS change category and HRQOL (overall and domain z scores) when controlling for demographic and clinical characteristics and were reported as β-coefficients with 95% confidence intervals.

Results

Complete data were analyzed for 195 (71%) children, including 127 with traumatic brain injury. New functional impairment was common with 32 (16%) patients experiencing FSS increases ≥ 3, 50 (26%) patients with FSS increases of 1–2 points, and 113 (58%) patients with no change from prehospital baseline. The majority of children (63%) demonstrated HRQOL ratings ≥ 1 standard deviation below healthy age-based standards (z scores ≤ − 1). Regression models demonstrated older age, female sex, presence of comorbidities, and preadmission cardiopulmonary resuscitation were all significantly associated with poorer overall HRQOL (all p < 0.05). FSS increase ≥ 3 at discharge was significantly associated with worse overall HRQOL at follow-up (β = − 1.07; 95% confidence interval = − 1.63 to − 0.52) when controlling for the aforementioned significant factors, and significantly improved model fit (p value for change = 0.001). Similar findings in secondary analyses were found for physical domain scores, with FSS increase showing a significant association with worse physical HRQOL scores and improvements in model fit. Change in FSS was not significantly associated with other HRQOL domain scores (emotional, social, school, psychosocial).

Conclusions

Many children with ABI after critical care experience new functional impairments (FSS increases) and worse HRQOL than healthy peers. FSS increase at discharge is a significant risk factor for worse HRQOL in the months after hospital discharge and improves HRQOL models beyond illness and demographic variables alone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Williams CN, Eriksson CO, Kirby A, et al. Hospital mortality and functional outcomes in pediatric neurocritical care. Hosp Pediatr. 2019;9(12):958–66.

    Article  Google Scholar 

  2. Pollack MM, Holubkov R, Funai T, et al. Pediatric intensive care outcomes: development of new morbidities during pediatric critical care. Pediatr Crit Care Med. 2014;15(9):821.

    Article  Google Scholar 

  3. Pollack MM, Holubkov R, Funai T, et al. Relationship between the functional status scale and the pediatric overall performance category and pediatric cerebral performance category scales. JAMA Pediatr. 2014;168(7):671–6.

    Article  Google Scholar 

  4. Manning JC, Pinto NP, Rennick JE, Colville G, Curley MA. Conceptualizing post intensive care syndrome in children—the PICS-p framework. Pediatr Crit Care Med. 2018;19(4):298–300.

    Article  Google Scholar 

  5. Watson RS, Choong K, Colville G, et al. Life after critical illness in children—toward an understanding of pediatric post-intensive care syndrome. J Pediatr. 2018;198:16–24.

    Article  Google Scholar 

  6. Herrup EA, Wieczorek B, Kudchadkar SR. Characteristics of postintensive care syndrome in survivors of pediatric critical illness: a systematic review. World J Crit Care Med. 2017;6(2):124.

    Article  Google Scholar 

  7. Williams CN, Hartman ME, Guilliams KP, et al. Postintensive care syndrome in pediatric critical care survivors: therapeutic options to improve outcomes after acquired brain injury. Curr Treat Options Neurol. 2019;21(10):49.

    Article  Google Scholar 

  8. Hartman ME, Williams CN, Hall TA, Bosworth CC, Piantino JA. Post-intensive care syndrome for the pediatric neurologist. Pediatr Neurol. 2020;108:47–53.

    Article  Google Scholar 

  9. Hall TA, Leonard S, Bradbury K, et al. Post-intensive care syndrome in a cohort of infants & young children receiving integrated care via a pediatric critical care & neurotrauma recovery program: a pilot investigation. Clin Neuropsychol. 2020. https://doi.org/10.1080/13854046.2020.1797176.

    Article  PubMed  Google Scholar 

  10. Cordts KMP, Hall TA, Hartman ME, et al. Sleep measure validation in a pediatric neurocritical care acquired brain injury population. Neurocrit Care. 2019;33:1–11.

    Google Scholar 

  11. Aspesberro F, Fesinmeyer MD, Zhou C, Zimmerman JJ, Mangione-Smith R. Construct validity and responsiveness of the pediatric quality of life inventory 4.0 generic core scales and infant scales in the PICU. Pediatr Crit Care Med. 2016;17(6):e272–9.

    Article  Google Scholar 

  12. Cunha F, Mota T, Teixeira-Pinto A, et al. Factors associated with health-related quality of life changes in survivors to pediatric intensive care. Pediatr Crit Care Med|Soc Crit Care Med. 2013;14(1):e8–15.

    Article  Google Scholar 

  13. Erickson SJ, Montague EQ, Gerstle MA. Health-related quality of life in children with moderate-to-severe traumatic brain injury. Dev Neurorehabil. 2010;13(3):175–81.

    Article  Google Scholar 

  14. Polic B, Mestrovic J, Markic J, et al. Long-term quality of life of patients treated in paediatric intensive care unit. Eur J Pediatr. 2013;172(1):85–90.

    Article  Google Scholar 

  15. Mestrovic J, Kardum G, Sustic A, et al. Neurodevelopmental disabilities and quality of life after intensive care treatment. J Paediatr Child Health. 2007;43(10):673–6.

    Article  Google Scholar 

  16. Brown EA, Kenardy J, Chandler B, et al. Parent-reported health-related quality of life in children with traumatic brain injury: a prospective study. J Pediatr Psychol. 2016;41(2):244–55.

    Article  Google Scholar 

  17. Knoester H, Bronner MB, Bos AP, Grootenhuis MA. Quality of life in children three and nine months after discharge from a paediatric intensive care unit: a prospective cohort study. Health Qual Life Outcomes. 2008;6(1):21.

    Article  Google Scholar 

  18. Green L, Godfrey C, Soo C, Anderson V, Catroppa C. A preliminary investigation into psychosocial outcome and quality-of-life in adolescents following childhood traumatic brain injury. Brain Inj. 2013;27(7–8):872–7.

    Article  CAS  Google Scholar 

  19. Colville G, Pierce C. Children’s self-reported quality of life after intensive care treatment. Pediatr Crit Care Med. 2013;14(4):446.

    Article  Google Scholar 

  20. Ambuehl J, Karrer A, Riedel T, Schibler A. Quality of life of survivors of paediatric intensive care. Swiss Med Wkly. 2007;137(21–22):312–6.

    PubMed  Google Scholar 

  21. Fineblit S, Selci E, Loewen H, Ellis M, Russell K. Health-related quality of life after pediatric mild traumatic brain injury/concussion: a systematic review. J Neurotrauma. 2016;33(17):1561–8.

    Article  Google Scholar 

  22. Aspesberro F, Mangione-Smith R, Zimmerman JJ. Health-related quality of life following pediatric critical illness. Intensive Care Med. 2015;41(7):1235–46.

    Article  Google Scholar 

  23. Conlon NP, Breatnach C, O’Hare BP, Mannion DW, Lyons BJ. Health-related quality of life after prolonged pediatric intensive care unit stay. Pediatr Crit Care Med. 2009;10(1):41–4.

    Article  Google Scholar 

  24. Namachivayam P, Taylor A, Montague T, et al. Long-stay children in intensive care: long-term functional outcome and quality of life from a 20-yr institutional study. Pediatr Crit Care Med|Soc Crit Care Med. 2012;13(5):520–8.

    Article  Google Scholar 

  25. Ebrahim S, Singh S, Hutchison JS, et al. Adaptive behavior, functional outcomes, and quality of life outcomes of children requiring urgent ICU admission. Pediatr Crit Care Med. 2013;14(1):10–8.

    Article  Google Scholar 

  26. Treble-Barna A, Beers SR, Houtrow AJ, et al. PICU-based rehabilitation and outcomes assessment: a survey of pediatric critical care physicians. Pediatr Crit Care Med. 2019;20(6):274–82.

    Article  Google Scholar 

  27. Dodd JN, Hall TA, Guilliams K, et al. Optimizing neurocritical care follow-up through the integration of neuropsychology. Pediatr Neurol. 2018;89:58–62.

    Article  Google Scholar 

  28. Williams CN, Kirby A, Piantino J. If you build it, they will come: initial experience with a multi-disciplinary pediatric neurocritical care follow-up clinic. Children. 2017;4(9):83.

    Article  Google Scholar 

  29. Bradbury K, Willimas CN, Leonard S, et al. Emotional aspects of pediatric post-intensive care syndrome following traumatic brain injury. J Child Adolesc Trauma. 2021;14(2):177–87.

    Article  Google Scholar 

  30. Williams CN, Lim MM, Shea SA. Sleep disturbance after pediatric traumatic brain injury: critical knowledge gaps remain for the critically injured. Nat Sci Sleep. 2018;10:225.

    Article  Google Scholar 

  31. Pinto NP, Rhinesmith EW, Kim TY, Ladner PH, Pollack MM. Long-term function after pediatric critical illness: results from the survivor outcomes study. Pediatr Crit Care Med. 2017;18(3):e122–30.

    Article  Google Scholar 

  32. Heneghan JA, Pollack MM. Morbidity: changing the outcome paradigm for pediatric critical care. Pediatr Clin. 2017;64(5):1147–65.

    Google Scholar 

  33. Varni JW, Seid M, Kurtin PS. PedsQLTM 4.0: reliability and validity of the Pediatric Quality of Life InventoryTM version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39:800–12.

    Article  CAS  Google Scholar 

  34. Varni JW, Limbers CA, Neighbors K, et al. The PedsQLTM infant scales: feasibility, internal consistency reliability, and validity in healthy and ill infants. Qual Life Res. 2011;20(1):45–55.

    Article  Google Scholar 

  35. Desai AD, Zhou C, Stanford S, Haaland W, Varni JW, Mangione-Smith RM. Validity and responsiveness of the pediatric quality of life inventory (PedsQL) 4.0 generic core scales in the pediatric inpatient setting. JAMA Pediatr. 2014;168(2):1114–21.

    Article  Google Scholar 

  36. Kruse S, Schneeberg A, Brussoni M. Construct validity and impact of mode of administration of the PedsQL among a pediatric injury population. Health Qual Life Outcomes. 2014;12(1):1–9.

    Article  Google Scholar 

  37. Bisegger C, Cloetta B, Von Bisegger U, Abel T, Ravens-Sieberer U. Health-related quality of life: gender differences in childhood and adolescence. Sozial-und Präventivmedizin. 2005;50(5):281–91.

    Article  Google Scholar 

  38. Varni JW, Limbers CA, Burwinkle TM. Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQLTM 4.0 Generic Core Scales. Health Qual Life Outcomes. 2007;5(1):43.

    Article  Google Scholar 

  39. Moreau JF, Fink EL, Hartman ME, et al. Hospitalizations of children with neurological disorders in the United States. Pediatr Crit Care Med. 2013;14(8):801.

    Article  Google Scholar 

  40. Williams CN, Piantino J, McEvoy C, Fino N, Eriksson CO. The burden of pediatric neurocritical care in the United States. Pediatr Neurol. 2018;89:31–8.

    Article  Google Scholar 

  41. Maddux AB, Cox-Martin M, Dichiaro M, Bennett TD. The association between the functional status scale and the pediatric functional independence measure in children who survive traumatic brain injury. Pediatr Crit Care Med. 2018;19(11):1046.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA

    Emily Z. Holding

  2. Division of Neurology, Children’s Hospital of Colorado, Aurora, CO, USA

    Elise M. Turner

  3. Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA

    Trevor A. Hall & Skyler Leonard

  4. Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, Portland, OR, USA

    Trevor A. Hall & Cydni N. Williams

  5. Children’s Neuropsychological Services, Boston, MA, USA

    Kathryn R. Bradbury

  6. Department of Pediatrics, Division of Critical Care, Oregon Health and Science University, Portland, OR, USA

    Cydni N. Williams

Authors
  1. Emily Z. Holding
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elise M. Turner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Trevor A. Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Skyler Leonard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kathryn R. Bradbury
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cydni N. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Drs. Holding, Turner, and Williams were involved in all aspects of manuscript preparation, including conceptualization, conducting statistical analyses, data collection, and writing of the artilce. Dr. Hall was involved in the study conceptualization, data collection and interpretation, and writing of the article. Drs. Leonard and Bradbury were involved in study conceptualization, data collection, and editing of the article. The final manuscript was approved by all authors.

Corresponding author

Correspondence to Emily Z. Holding.

Ethics declarations

Conflicts of interest

Dr. Williams reports grants from Agency for Healthcare Research and Quality, and grants from the National Heart Lung and Blood Institute, and National Institutes for Health during the conduct of the study. The remaining authors declare no conflicts of interest.

Ethical approval/informed consent

The authors have adhered to the ethical guidelines, and the research was conducted under a waiver from the institutional review board.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is related to the Invited commentary available at https://doi.org/10.1007/s12028-021-01270-9

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Holding, E.Z., Turner, E.M., Hall, T.A. et al. The Association Between Functional Status and Health-Related Quality of Life Following Discharge from the Pediatric Intensive Care Unit. Neurocrit Care 35, 347–357 (2021). https://doi.org/10.1007/s12028-021-01271-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-021-01271-8

Keywords

Search

Navigation