Functional progression of patients with neurological diseases in a tertiary paediatric intensive care unit: Our experience

• Published in: Neurologia (Barcelona, Spain) Vol. 35; no. 6; pp. 381 - 394
• Main Authors: Madurga Revilla, P, López Pisón, J, Samper Villagrasa, P, García Íñiguez, J P, Garcés Gómez, R, Domínguez Cajal, M, Gil Hernández, I
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01.07.2020
• Subjects: Adolescent; Child; Child, Preschool; Critical Care - statistics & numerical data; Disease Progression; Female; Hospitalization; Humans; Infant; Infant, Newborn; Intensive Care Units, Pediatric - statistics & numerical data; Length of Stay; Male; Nervous System Diseases - therapy; Outcome Assessment, Health Care - statistics & numerical data; Patient Discharge; Retrospective Studies; Salud funcional; Pediatric Overall and Cerebral Performance Categories; Prognosis; Pronóstico; Escala de estado funcional; Patología neurocrítica; Functional Status Scale; Pediatría; Categorías de estado global y cerebral pediátrico; Neurocritical disease; Functional health; Paediatrics
• ISSN: 1578-1968; 2173-5808
• DOI: 10.1016/j.nrl.2017.09.007

Neurological diseases explain a considerable proportion of admissions to paediatric intensive care units (PICU), and are a significant cause of morbidity and mortality. This study aims to analyse the functional progression of children with critical neurological conditions. Retrospective descriptive study of children admitted to PICU with neurological diseases over a period of 3 years (2012-2014), assessing vital and functional prognosis at PICU discharge and at one year according to the Pediatric Cerebral and Overall Performance Category scales (PCPC-POPC) and the Functional Status Scale (FSS). The results are compared with our previous data (1990-1999), and those of the international multicentre PANGEA study. A total of 266 children were studied. The mortality rate was 3%; the PRISM-III and PIM2 models did not show predictive ability. Clinically significant worsening was observed in functional health at discharge in 30% of the sample, according to POPC, 15% according to PCPC, and 5% according to FSS. After one year, functional performance improved according to PCPC-POPC, but not according to FSS. Children with no underlying neurological disease had a higher degree of functional impairment; this was prolonged over time. We observed a decrease in overall and neurocritical mortality compared with our previous data (5.60 vs. 2.1%, P=.0003, and 8.44 vs. 2.63%, P=.0014, respectively). Compared with the PANGEA study, both mortality and cerebral functional impairment in neurocritical children were lower in our study (1.05 vs. 13.32%, P<.0001, and 10.47% vs. 23.79%, P<.0001, respectively). Nearly one-third of critically ill children have neurological diseases. A significant percentage, mainly children without underlying neurological diseases, had a clinically significant functional impact at PICU discharge and after a year. Neuromonitoring and neuroprotection measures and the evaluation of functional progression are necessary to improve critical child care.