Functional outcome of children treated in an intensive care unit (ICU)

Introduction: Patients’ outcome is determined not only by the severity of the index illness, but also the impact of the patients’ pre-admission comorbid status. Aim: We intended to evaluate the outcome of patients treated in a pediatric ICU, with special emphasis on the group of children with chronic diseases. Methods and subjects: The data was obtained prospectively and outcome was assessed according to the Pediatric Overall Performance Category (POPC) scale for 449 sick children in the pediatric ICU of Split University Hospital. Functional performance was assessed as the pre-admission score and the discharge score in patients with neurodevelopmental disabilities, patients with other chronic diesases, and those without a chronic disease. POPC is a six-point scale ranging from the score of 1 (normal) to 6 (dead), with interim points representing progressively greater functional impairment. Each scale category is accompanied by age-appropriate operational definitions. Functional performance of patients was assessed as the baseline, pre-admission score (bPOPC), prior to the index disease, based on an interview with each child’s parent. The discharge functional score (dPOPC) was evaluated before transfer of patients from the PICU. Results: The discharge functional status was significantly dependent on the pre-admission functional status and the predicted mortality. Children with neurodevelopmental disabilities had a significantly worse baseline score and significantly smaller deterioration of functional morbidity at discharge compared to children with no chronic disease and children with other chronic diseases. Conclusions: The POPC scale proved its applicability in a small ICU, with a heterogenous population of patients. It should therefore be considered for regular evaluation of the quality of health care, as a simple and accurate tool. As opposed to other patients, the functional status of children with neurodevelopmental disabilities was markedly influenced by their comorbidity. Their pre-admission status was worse than the status of other children, and hence could not deteriorate significantly at discharge.
Category: Abstracts
Volume: Vol. 52, No 3, july - september 2008
Authors: M. Meštrović, J. Meštrović, B. Polić, E. Marušić
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