Functional outcomes and clinical characteristics of children discharged from a low-income pediatric intensive care unit: A 5 years’ experience study

Abstract

Background: The evolution of pediatric intensive care units (PICUs) has hand out to the improvement in the survival of critically ill children, in spite of that, the long-term functional outcome (after one year of admission to the PICU) of these children is often unknown in many countries including Rwanda. Objective: This study aimed to report the prevalence and type of long-term functional outcomes and their associated clinical characteristics encountered in children who were discharged from the PICU for a period of 5 years. Methods: A cross-sectional study done at Kigali University Teaching Hospital (PICU); a pediatric cerebral performance category (PCPC) and pediatric overall performance category (POPC) scales were used to screen for long-term functional outcomes. The results were evaluated by telephone interview. The resulting data were entered and analyzed using SPSS version 25. Multivariate logistic regression was used to determine factors associated with poor functional outcomes. Results: In total, 158 children who were included in this study, considering PCPC and POPC: 40.5% and 20.9% were normal, 13.3% and 23.4% have a mild disability, 11.4 % and 20.3% have moderate disability, 5.1% and 5.7% have severe disability, 3.8% and 3.8% were in a coma / vegetative state, 25.9% and 25.9 % died after leaving the PICU. This means that those who achieved a PCPC 65.2% and POPC 64.6% score had good functional outcomes. Physical impairments were more observed than cognitive impairments. Have at least one comorbidity [PCPC (aOR 2.69, 95% C.I1.21-6.0, p = 0.015) and POPC (aOR 2.59, 95% CI 1.16-5.75, p = 0.019)], neurological diseases [PCPC (aOR 2.54.95% CI 0.8-7.9, p = 0.107 and POPC (aOR 2.5.95% CI 0.8-7.7, p = 0.113)], and oncological diseases [PCPC (p = 0.002) and POPC (p <0.001)], were found to be significantly correleted with poor functional outcomes. Conclusion: Assessing Functional outcome is an important outcome measure in critically ill children. This research contributes new knowledge towards a better understanding of functional outcomes, recovery, and factors that impact aspects of functioning in children after severe illness. It shows that remaining functional morbidity persevere and is different for each patient and explain the essential of follow-up post discharge from the PICU.