(698) Functional Status of Children With Pediatric Chronic Critical Illness: A Single-Center Study

Introduction: Pediatric chronic critical illness(PCCI) is defined by a prolonged stay in the pediatric intensive care unit(PICU) and medical technology dependence after critical illness. This study aims to describe the functional status of PCCI patients. We hypothesized that children with pre-existing complex chronic disease(C-CD) will have greater functional deterioration on PICU discharge compared to those without.

Methods: This was a retrospective study of patients admitted to a mixed PICU for ≥14 consecutive days. Patients with PCCI were divided into 2 groups: those with and without pre-existing C-CD, defined by the Pediatric Medical Complexity Algorithm. Primary outcome was increase of Functional Status Score(FSS) at PICU discharge compared to baseline. Secondary outcomes were PICU mortality and medical technology dependence in feeding and respiratory domains on PICU discharge. We summarized continuous and categorical variables in medians(interquartile range) and counts(percentages), respectively.

Results: Of 40 children with PCCI [age 2.85, (0.46-8.27) years], 24 (60.0%) had pre-existing C-CD, predominantly malignancy (20.8%). Overall PIM-3 score was 2.47 (0.6-11.7) and mortality rate was 7/40 (17%). Baseline FSS was 8(6-17) and 6(6-6) in C-CD and non C-CD patients, respectively(p=0.01). On PICU discharge, non C-CD patients had a greater increase in FSS compared to C-CD patients [11.5(5-16) vs. 3(0-6.5), p < 0.01]. Median FSS on PICU discharge was 13.5 (9.0 – 22.5) in patients with C-CD and 18 (13.0-22.0) in those without C-CD(p = 0.376). For combined feeding and respiratory domains, non C-CD patients had a higher score increase compared to C-CD patients[5(2-5) vs. 2(0-4), p=0.045]. At PICU discharge, 8(61.5%) survivors without pre-existing C-CD were diagnosed with C-CD on discharge.

Conclusions: Pediatric patients without pre-existing C-CD had greater functional deterioration and increased medical technology dependence on PICU discharge. This suggests that this group of patients may require further resources to support them during and post critical illness.