TY - JOUR
T1 - Defining Pediatric Chronic Critical Illness
T2 - A Scoping Review∗
AU - Zorko, David J.
AU - McNally, James Dayre
AU - Rochwerg, Bram
AU - Pinto, Neethi
AU - O'Hearn, Katie
AU - Almazyad, Mohammed A.
AU - Ames, Stefanie G.
AU - Brooke, Peter
AU - Cayouette, Florence
AU - Chow, Cristelle
AU - Junior, José Colleti
AU - Francoeur, Conall
AU - Heneghan, Julia A.
AU - Kazzaz, Yasser M.
AU - Killien, Elizabeth Y.
AU - Jayawarden, Supun Kotteduwa
AU - Lasso, Ruben
AU - Lee, Laurie A.
AU - O'Mahony, Aoife
AU - Perry, Mallory A.
AU - Rodríguez-Rubio, Miguel
AU - Sandarage, Ryan
AU - Smith, Hazel A.
AU - Welten, Alexandra
AU - Yee, Belinda
AU - Choong, Karen
AU - Morrow, Brenda
AU - Henderson, Carrie
AU - Chiusolo, Fabrizio
AU - Lee, Jan Hau
AU - Wollny, Krista
AU - Pratt, Misty
AU - Bartel, Nicholas
AU - Hirschfeld, Ryan
N1 - Publisher Copyright: Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.Unauthorized reproduction of this article is prohibited.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - OBJECTIVES: Children with chronic critical illness (CCI) are hypothesized to be a high-risk patient population with persistent multiple organ dysfunction and functional morbidities resulting in recurrent or prolonged critical care; however, it is unclear how CCI should be defined. The aim of this scoping review was to evaluate the existing literature for case definitions of pediatric CCI and case definitions of prolonged PICU admission and to explore the methodologies used to derive these definitions. DATA SOURCES: Four electronic databases (Ovid Medline, Embase, CINAHL, and Web of Science) from inception to March 3, 2021. STUDY SELECTION: We included studies that provided a specific case definition for CCI or prolonged PICU admission. Crowdsourcing was used to screen citations independently and in duplicate. A machine-learning algorithm was developed and validated using 6,284 citations assessed in duplicate by trained crowd reviewers. A hybrid of crowdsourcing and machine-learning methods was used to complete the remaining citation screening. DATA EXTRACTION: We extracted details of case definitions, study demographics, participant characteristics, and outcomes assessed. DATA SYNTHESIS: Sixty-seven studies were included. Twelve studies (18%) provided a definition for CCI that included concepts of PICU length of stay (n = 12), medical complexity or chronic conditions (n = 9), recurrent admissions (n = 9), technology dependence (n = 5), and uncertain prognosis (n = 1). Definitions were commonly referenced from another source (n = 6) or opinion-based (n = 5). The remaining 55 studies (82%) provided a definition for prolonged PICU admission, most frequently greater than or equal to 14 (n = 11) or greater than or equal to 28 days (n = 10). Most of these definitions were derived by investigator opinion (n = 24) or statistical method (n = 18). CONCLUSIONS: Pediatric CCI has been variably defined with regard to the concepts of patient complexity and chronicity of critical illness. A consensus definition is needed to advance this emerging and important area of pediatric critical care research.
AB - OBJECTIVES: Children with chronic critical illness (CCI) are hypothesized to be a high-risk patient population with persistent multiple organ dysfunction and functional morbidities resulting in recurrent or prolonged critical care; however, it is unclear how CCI should be defined. The aim of this scoping review was to evaluate the existing literature for case definitions of pediatric CCI and case definitions of prolonged PICU admission and to explore the methodologies used to derive these definitions. DATA SOURCES: Four electronic databases (Ovid Medline, Embase, CINAHL, and Web of Science) from inception to March 3, 2021. STUDY SELECTION: We included studies that provided a specific case definition for CCI or prolonged PICU admission. Crowdsourcing was used to screen citations independently and in duplicate. A machine-learning algorithm was developed and validated using 6,284 citations assessed in duplicate by trained crowd reviewers. A hybrid of crowdsourcing and machine-learning methods was used to complete the remaining citation screening. DATA EXTRACTION: We extracted details of case definitions, study demographics, participant characteristics, and outcomes assessed. DATA SYNTHESIS: Sixty-seven studies were included. Twelve studies (18%) provided a definition for CCI that included concepts of PICU length of stay (n = 12), medical complexity or chronic conditions (n = 9), recurrent admissions (n = 9), technology dependence (n = 5), and uncertain prognosis (n = 1). Definitions were commonly referenced from another source (n = 6) or opinion-based (n = 5). The remaining 55 studies (82%) provided a definition for prolonged PICU admission, most frequently greater than or equal to 14 (n = 11) or greater than or equal to 28 days (n = 10). Most of these definitions were derived by investigator opinion (n = 24) or statistical method (n = 18). CONCLUSIONS: Pediatric CCI has been variably defined with regard to the concepts of patient complexity and chronicity of critical illness. A consensus definition is needed to advance this emerging and important area of pediatric critical care research.
KW - chronic critical illness
KW - chronic disease
KW - critical care
KW - intensive care units
KW - pediatrics
UR - https://www.scopus.com/pages/publications/85146830840
U2 - 10.1097/PCC.0000000000003125
DO - 10.1097/PCC.0000000000003125
M3 - Review article
C2 - 36661428
SN - 1529-7535
VL - 24
SP - E91-E103
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 2
ER -