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

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

Autor: Madurga Revilla, P.; López Pisón, J.; Samper Villagrasa, P.; García Íñiguez, J. P.; Garcés Gómez, R.; Domínguez Cajal, M.; Gil Hernández, I.

Publication year: 2020

Neurologia

issn:2173-5808

doi: 10.1016/j.nrl.2017.09.007

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Abstract:

INTRODUCTION: 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. MATERIAL AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. Language: spa Rights: Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved. Pmid: 29174722 Tags: Humans; Female; Male; Retrospective Studies; Child; Infant, Newborn; Adolescent; Child, Preschool; Infant; Prognosis; Patient Discharge; Hospitalization; Disease Progression; Length of Stay; Paediatrics; Categorías de estado global y cerebral pediátrico; Escala de estado funcional; Functional health; Nervous System Diseases/*therapy; Salud funcional; Critical Care/statistics & numerical data; Functional Status Scale; Intensive Care Units, Pediatric/*statistics & numerical data; Neurocritical disease; Outcome Assessment, Health Care/statistics & numerical data; Patología neurocrítica; Pediatría; Pediatric Overall and Cerebral Performance Categories; Pronóstico Link: https://pubmed.ncbi.nlm.nih.gov/29174722/