Acute Crit Care.  2022 Nov;37(4):627-635. 10.4266/acc.2022.00234.

Incidence and associated factors of pediatric post-intensive care syndrome using the VSCAREMD model

Affiliations
  • 1Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
  • 2Division of Pediatric Critical Care, Department of Pediatrics, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand

Abstract

Background
The VSCAREMD model is used for evaluating vaccination, sleep, and parental care burden, which includes daily activity and social interaction, rehabilitation requirements, hearing, mood, and development. It has been proposed to detect post-intensive care syndrome (PICS) in children. This study aimed to outline the incidence of PICS in children using the VSCAREMD model and to describe the associated factors. Methods: All children ages 1 month to 15 years and admitted to the intensive care unit for at least 48 hours were evaluated using the VSCAREMD model within 1 week of intensive care discharge. Abnormal findings were assorted into four domains: physical, cognitive, mental, and social. Descriptive statistics were performed using chi-square, univariate, and multivariate analyses. Results: A total of 78 of 95 children (82.1%) had at least one abnormal domain. Physical, cognitive, mental, and social morbidity were found in 64.2%, 26.3%, 13.7%, and 38.9% of the children, respectively. Prolonged intensive care unit stay greater than 7 days was associated with dysfunction in physical (adjusted odds ratio [aOR], 3.80; 95% confidence interval [CI], 1.31–11.00), cognitive (aOR, 10.11; 95% CI, 3.01–33.89), and social domains (aOR, 5.01; 95% CI, 2.01–12.73). Underlying medical conditions were associated with cognitive (aOR, 13.63; 95% CI, 2.64– 70.26) and social morbidity (aOR, 2.81; 95% CI, 1.06–7.47). Conclusions: The incidence of PICS using the VSCAREMD model was substantially high and associated with prolonged intensive care. This model could help evaluate PICS in children.

Keyword

children; intensive care; morbidity

Reference

1. 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; 19:298–300.
Article
2. Ong C, Lee JH, Leow MK, Puthucheary ZA. Functional outcomes and physical impairments in pediatric critical care survivors: a scoping review. Pediatr Crit Care Med. 2016; 17:e247–59.
3. 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; 6:124–34.
Article
4. Inoue S, Hatakeyama J, Kondo Y, Hifumi T, Sakuramoto H, Kawasaki T, et al. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg. 2019; 6:233–46.
Article
5. Namachivayam P, Shann F, Shekerdemian L, Taylor A, van Sloten I, Delzoppo C, et al. Three decades of pediatric intensive care: who was admitted, what happened in intensive care, and what happened afterward. Pediatr Crit Care Med. 2010; 11:549–55.
Article
6. Jones S, Rantell K, Stevens K, Colwell B, Ratcliffe JR, Holland P, et al. Outcome at 6 months after admission for pediatric intensive care: a report of a national study of pediatric intensive care units in the United Kingdom. Pediatrics. 2006; 118:2101–8.
Article
7. Als LC, Picouto MD, Hau SM, Nadel S, Cooper M, Pierce CM, et al. Mental and physical well-being following admission to pediatric intensive care. Pediatr Crit Care Med. 2015; 16:e141–9.
Article
8. Als LC, Nadel S, Cooper M, Pierce CM, Sahakian BJ, Garralda ME. Neuropsychologic function three to six months following admission to the PICU with meningoencephalitis, sepsis, and other disorders: a prospective study of school-aged children. Crit Care Med. 2013; 41:1094–103.
9. Als LC, Tennant A, Nadel S, Cooper M, Pierce CM, Garralda ME. Persistence of neuropsychological deficits following pediatric critical illness. Crit Care Med. 2015; 43:e312–5.
Article
10. Bronner MB, Knoester H, Bos AP, Last BF, Grootenhuis MA. Posttraumatic stress disorder (PTSD) in children after paediatric intensive care treatment compared to children who survived a major fire disaster. Child Adolesc Psychiatry Ment Health. 2008; 2:9.
Article
11. Colville G, Kerry S, Pierce C. Children's factual and delusional memories of intensive care. Am J Respir Crit Care Med. 2008; 177:976–82.
Article
12. Rees G, Gledhill J, Garralda ME, Nadel S. Psychiatric outcome following paediatric intensive care unit (PICU) admission: a cohort study. Intensive Care Med. 2004; 30:1607–14.
Article
13. Pediatric Infectious Disease Society of Thailand. Expanded program of immunization for normal children [Internet]. Bangkok: Pediatric Infectious Disease Society of Thailand; 2019 [cited 2022 Jan 6]. Available from: https://www.pidst.or.th/A626.html.
14. Owens JA, Dalzell V. Use of the 'BEARS' sleep screening tool in a pediatric residents' continuity clinic: a pilot study. Sleep Med. 2005; 6:63–9.
Article
15. Bédard M, Molloy DW, Squire L, Dubois S, Lever JA, O'Donnell M. The Zarit burden interview: a new short version and screening version. Gerontologist. 2001; 41:652–7.
16. Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry. 1997; 38:581–6.
Article
17. Pollack MM, Holubkov R, Glass P, Dean JM, Meert KL, Zimmerman J, et al. Functional status scale: new pediatric outcome measure. Pediatrics. 2009; 124:e18–28.
Article
18. Neumann K, Indermark A. Validation of a new TEOAE-AABR device for newborn hearing screening. Int J Audiol. 2012; 51:570–5.
Article
19. Yin L, Bottrell C, Clarke N, Shacks J, Poulsen MK. Otoacoustic emissions: a valid, efficient first-line hearing screen for preschool children. J Sch Health. 2009; 79:147–52.
Article
20. Johnson JL, White KR, Widen JE, Gravel JS, James M, Kennalley T, et al. A multicenter evaluation of how many infants with permanent hearing loss pass a two-stage otoacoustic emissions/automated auditory brainstem response newborn hearing screening protocol. Pediatrics. 2005; 116:663–72.
Article
21. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association; 2013.
22. Hagan JF, Shaw JS, Duncan PM. Bright futures: guidelines for health supervision of infants, children, adolescents. 3rd ed. Elk Grove Village: American Academy of Pediatrics; 2008.
23. Batt J, Mathur S, Katzberg HD. Mechanism of ICU-acquired weakness: muscle contractility in critical illness. Intensive Care Med. 2017; 43:584–6.
Article
24. Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med. 1996; 24:743–52.
25. Cohen MJ. Children’s memory scale. In: Kreutzer JS, DeLuca J, Caplan B, editors. Encyclopedia of clinical neuropsychology [Internet]. New York (NY): Springer; 2011 [cited 2022 Jan 6]. Available from: https://doi.org/10.1007/978-0-387-79948-3.
26. Peterson-Carmichael SL, Cheifetz IM. The chronically critically ill patient: pediatric considerations. Respir Care. 2012; 57:993–1002.
Article
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