Trajectories of Post Intensive Care Syndrome in Children During First Six Months Post-Discharge.

Background and Aims: Health outcome trajectories in critically ill children remain poorly described. We aimed to examine the trajectories of post-intensive care syndrome within six-months post-pediatric intensive care unit (PICU) discharge.

Methods: Data were collected upon PICU admission, discharge and at 1-, 3-, and 6-months post-discharge using the Pediatric Quality-of-Life scale (PedsQL™), Young Child PTSD Screen, and Functional Status Scale. Group-based trajectory modelling was used to identify distinct longitudinal health outcome trajectories.

Results: 135 children completed follow- up and were categorised into three trajectory groups based on their health outcomes. Theme an (SD) age was 5.6(5.5) years, with PIM III score of 3.2(4.1)and the average length-of-PICU admission was 10(21) days. Overall, PedsQL scores plateaued at 3-months after discharge. At three and six months, 30 (28%) and 19(35%) children, respectively exhibited symptoms consistent with PTSD. Fifteen (11%)children in the severe group reported worst PedsQL and functional scores at six-months after discharge, 17(15%) in the mildand 103(65%) in the moderate group demonstrated recovery to baseline. Children in the severe group were older (8.3 vs 5.4 and3.6 years, p.007), were more likely to have pre-existing illnesses(11(73%) vs 42(41%) and 6(35%), p.050) and satisfied criteria for PTSD (5(30%) vs 14(13%) and 0(0%), p.024) as compared to the moderate and mild groups.

Conclusions: Patients in the severe group were less likely to recover to baseline and reported worse health outcomes at six-months. The three-month mark post-discharge serves as acritical point for evaluation allowing early identification and intervention for rehabilitation.