Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

Table 1 Summary of included studies

Ref.	Design	n	Age	Patient sample	Timing of follow-up	Measures used	Main findings
Physical morbidity after pediatric critical illness
Als et al[8]	Prospective cohort	88 (100 controls)	5-16 yr	PICU admission for ≥ 28 d	5 mo (median)	Strengths and Difficulties Questionnaire; Chalder Fatigue Scale; Children’s Sleep Habits Questionnaire; Impact of Event Scale	Significant minority of school aged children at risk for short-term physical morbidity
Colville et al[13]	Prospective cohort	97	> 7 yr		3 mo and 1 yr	Pediatric QOL Inventory	PQLI scores lower at 3 mo compared to non-clinical community sample but comparable at 1 yr Physical functioning subscale lower in PICU survivors but improved over time
Gemke et al[15]	Prospective cohort	226	Children up to 16 yr, excluding infants		1 yr	Multiattribute health status classification	Health status in 75% of population preserved
Jayashree et al[16]	Prospective cohort	150	1-12 yr		1 yr	Multiattribute Health Status Classification	QOL preserved in approximately 75% of patients Neurological illness risk factor for decline in QOL
Jones et al[17]	Descriptive study	1455	≥ 6 mo		6 mo	Health Utilities Index 2	27% of children with no impairments
Knoester et al[18]	Prospective cohort	81	1-15 yr		3 mo and 9 mo	Children’s QOL Questionnaire	Health related QOL improves over time
Namachivayam et al[20]	Cohort study and prospective database review	4010	All ages including adults at time of follow-up		2.5-3 yr (1982); 2.5-6 yr (1995); 0.5-2.9 yr (2005-2006)	Modified Glasgow Outcome Score; Health Status Utility Index	Proportion of survivors with moderate or severe disability ↑ in 2005-2006 compared to 1982 and 1995
Namachivayam et al[21]	Prospective cohort	233	Median 4.2 mo at admission	Long-stay patients	> 6 mo; median of 4 yr	Modified Glasgow Outcome Scale; Health Utilities Index Mark 1	Long term functional outcome favorable in 50% of survivors QOL poor in 68%
Taylor et al[25]	Prospective cohort	1032	0-29 yr		2-6 yr	Glasgow Outcome Score; Health State Utility Index Mark 1	Majority of children survive with excellent QOL and functional outcome
Neurocognitive morbidity after pediatric critical illness
Als et al[7]	Prospective cohort	88 (100 controls)	5-16 yr		3-6 mo	Same as Als 2015	Children have deficits in neuropsychologic performance and school performance
Als et al[9]	Prospective cohort	23	5-16 yr		1 yr	Cambridge Neuropsychological Automated Battery; Children’s Memory Scale; Wechsler Abbreviated Scale of Intelligence or Wide Range Intelligence Test	Persistently reduced neuropsychological function in PICU survivors
Psychological morbidity after pediatric critical illness
Als et al[8]	Prospective cohort	88 (+ 100 controls)	5-16 yr	PICU admission for ≥ 28 d	5 mo (median)	Strengths and Difficulties Questionnaire; Chalder Fatigue Scale; Children’s Sleep Habits Questionnaire; Impact of Event Scale	Significant minority of school aged children at risk for short-term mental morbidity
Bronner et al[10]	Prospective cohort	36	8-17 yr		3 mo and 9 mo	Dutch Children’s Responses to Trauma Inventory	34.5% of children had subclinical PTSD 13.8% likely to meet criteria for PTSD
Colville et al[11]	Prospective cohort	102	7-17 yr		3 mo	ICU Memory Tool; abbreviated Impact of Event Scale	32% reported delusional memories Post-traumatic stress scores higher in those with delusional memories Longer courses of opiates/benzos associated with delusional memories
Colville et al[12]	Prospective cohort	66	7-17 yr		3 mo and 12 mo	Children’s Revised Impact of Event Scale	At 3 mo, 32% of children experienced posttraumatic stress symptoms; 26% at 12 mo
Dow et al[14]	Prospective cohort	59	6-16 yr		6 mo	Children’s PTSD Inventory	Minority (17%-29%) of children met PTSD criteria
Muranjan etal[19]	Prospective cohort	30	≥ 5 yr	Age and sex matched to pediatric general wards patients	1 mo	Impact of Event Scale; Birleson Depression Scale; Self-Esteem Scale; Therapeutic Interventions Scoring System; Temperament Measurement Schedule	PICU patients subjected to therapeutic interventions have transient psychological impairment following admission
Rees et al[22]	Retrospective cohort	68	5-18 yr	Compared to general ward patients	6-12 mo	Clinician Administered PTSD Scale for Children; Impact of Event Scale; Strengths and Difficulties Questionnaire; Birleson Depression Scale; Revised Children’s Manifest Anxiety Scale; Child Somatization Inventory	21% of PICU patients developed PTSD compared to none of the ward patients
Rennick et al[23]	Prospective cohort	60 per cohort	6-17 yr	Age and sex matched to pediatric general wards patients	6 wk and 6 mo	Invasive Procedure Score; Children’s Impact of Event Scale; Posthospital Behavior Questionnaire; Children’s Health Locus of Control Scale; Child Medical Fear Scale	Regardless of hospital location: greater degree of invasiveness, illness severity and younger age contribute to higher likelihood of posttraumatic stress response after discharge
Rennick et al[24]	Prospective cohort	60	6-17 yr		6 wk and 6 mo	Children’s Impact of Event Scale; Children’s Medical Fears Scale; Children’s Health Locus of Control Scale	Children who have high numbers of invasive procedures at higher risk of developing psychological morbidity 6 wk after discharge

PICU: Pediatric intensive care unit; PTSD: Post-traumatic stress disorder; QOL: Quality of life.