Follow up of survival and quality of life in children after intensive care.

ABSTRACT

OBJECTIVE:To evaluate the health related quality of life of children after intensive care and to assess their long term survival. DESIGN: Prospective. Setting: Tertiary Care Hospital Intensive Care Unit (ICU). SUBJECT AND METHODS: All patients admitted to ICU were enrolled prospectively over a period of 1 year. Children with ICU stay of less than 24 hrs, infants, readmission to ICU were however excluded. Survival was determined at the time of ICU discharge and 1 year later. Health status assessment was done with the help of the multiattribute health status classification (MAHSC), which has 6 domains; sensation, mobility, emotion, cognition, self care and pain. Assessment was done at two points of time - within 48 hours of admission to the ICU and 1 year after discharge. RESULTS: 150 children (mean age 5.68+/- 3.6 years) with a mean duration of ICU stay (5.7 +/- 5.5 days) were included in the study. The cumulative ICU mortality was 12.9%. Fifty-five (36.7% had no overall health impairment (no affected domains) preceding the present illness. There was overall health impairment (?1 affected domain) preceding the present illness in 95 of the 150 patients (63.3%). In the domain specific health status mobility was affected in 74 (49%) followed by pain 61 (41.2%), self care 56 (38.8%), sensation 29 (20%), cognition 21 (14.8%) and emotion 14(9.5%). After 1 year, overall state of health had improved or was equal to the premorbid state in 87 (75%). In domain specific health, the proportion improving or remaining unchanged varied from 75% (emotional) to 80% (cognition), 85.3% (pain) and 88.7% (mobility). The overall state of health had worsened as compared to the premorbid state in 29 (25%) majority with neurological illnesses. CONCLUSION: Quality of life in three-quarters of the patients was preserved and one year survival was favorable. Worsening was noted primarily in-patients with neurological illnesses.