Assessing Functional Outcomes in the Pediatric Neurocritical Care Population after Discharge: A Pilot Study.

Objectives: Pediatric neurocritical care (PNCC) patients experience high rates of morbidity, but comprehensive follow-up is not universal. We sought to identify predictors of functional decline in these children to guide future resource allocation.

Patients And Methods: We conducted a prospective observational study in a quaternary children's hospital pediatric intensive care unit (PICU) from July 2023 to December 2023. Patients (aged 3-17 years) were admitted with a PNCC diagnosis, and their caregivers were enrolled. Outcomes were assessed through surveys using the Functional Status Scale (FSS) at time of consent (baseline) and the 2-month follow-up after PICU discharge. Follow-up surveys explored social, educational, and cognitive difficulties encountered after discharge. Functional decline was defined as any increase in FSS between baseline and follow-up, and severe morbidity was defined as an overall increase of 3 or more or an increase of 2 or more in one domain. Demographic and in-hospital variables were extracted from a clinical database to analyze with outcomes.

Results: A total 30 of 31 families consented, and 29 completed follow-up surveys. Out of those, 17 (58.6%) patients had a functional decline, 8 (27.6%) had a new severe morbidity, only 12 (41.4%) had returned to school, and 16 (55.2%) had new family hardships. Mechanical ventilation was a significant predictor of functional decline (odds ratio, 6.50, 95% CI, 1.26-33.58; P = .025).

Conclusions: This study supplements reports of high morbidity after pediatric neurocritical illness. Targeting patients most at risk for functional decline, such as those receiving mechanical ventilation, can support efficient resource allocation for follow-up programs promoting health-related quality of life. Larger studies are needed to validate and expand on these findings.