Overall Health Following Pediatric Critical Illness: A Scoping Review of Instruments and Methodology

Erin F. Carlton, University of Michigan Medical School
Neethi Pinto, University of Pennsylvania Perelman School of Medicine
McKenna Smith, University of Utah School of Medicine
Ericka L. Fink, University of Pittsburgh School of Medicine
R. Scott Watson, University of Washington School of Medicine
K. Sarah Hoehn, Department of Pediatrics, The University of Chicago
Neelima Marupudi, Department of Pediatrics, The University of Chicago
Leslie A. Dervan, University of Washington School of Medicine
Mellanye Lackey, University of Nevada, Las Vegas
Melissa Ringwood, University of Utah School of Medicine
Aline B. MadduxS, University of Colorado School of Medicine


OBJECTIVES: Families identify overall health as a key outcome after pediatric critical illness. We conducted a planned secondary analysis of a scoping review to determine the methods, populations, and instruments used to evaluate overall health outcomes for both children and their families after critical illness. DESIGN: Planned Secondary Analysis of a Scoping Review. SETTING: We searched PubMed, EMBASE, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Controlled Trials Registry databases from 1970 to 2017 to identify studies which measured postdischarge overall health of children who survived critical illness and their families. SUBJECTS: Articles reporting overall health outcomes after pediatric critical illness. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 407 articles which measured outcomes following pediatric critical illness, 161 (40%) measured overall health. The overall health domain was most commonly measured in traumatic brain injury (44%) and the general PICU populations (16%). In total, there were 39 unique measures used to evaluate overall health. Across all subjects, seven measures accounted for 89% of instruments, with the Glasgow Outcome Scale (47%) and the Pediatric Overall Performance Category (17%) being most commonly used. Excluding studies targeting survivors of traumatic brain injury, Pediatric Overall Performance Category, Glasgow Outcome Scale, and the General Health Questionnaire were the most commonly used instruments. Patients were followed for a median 10.5 months (interquartile range, 4.5-21 mo). CONCLUSIONS: Overall health was commonly assessed post-PICU discharge, especially in the traumatic brain injury population, using a heterogenous array of measures. Evaluation and consensus are imperative to identify the most appropriate method to measure overall health with the goal of improving care efficacy and facilitating recovery across populations of critically ill children.