Defining Pediatric Chronic Critical Illness: A Scoping Review∗

David J. Zorko; James Dayre McNally; Bram Rochwerg; Neethi Pinto; Katie O'Hearn; Mohammed A. Almazyad; Stefanie G. Ames; Peter Brooke; Florence Cayouette; Cristelle Chow; José Colleti Junior; Conall Francoeur; Julia A. Heneghan; Yasser M. Kazzaz; Elizabeth Y. Killien; Supun Kotteduwa Jayawarden; Ruben Lasso; Laurie A. Lee; Aoife O'Mahony; Mallory A. Perry; Miguel Rodríguez-Rubio; Ryan Sandarage; Hazel A. Smith; Alexandra Welten; Belinda Yee; Karen Choong; Brenda Morrow; Carrie Henderson; Fabrizio Chiusolo; Jan Hau Lee; Krista Wollny; Misty Pratt; Nicholas Bartel; Ryan Hirschfeld

doi:10.1097/PCC.0000000000003125

Defining Pediatric Chronic Critical Illness: A Scoping Review∗

David J. Zorko, James Dayre McNally, Bram Rochwerg, Neethi Pinto, Katie O'Hearn, Mohammed A. Almazyad, Stefanie G. Ames, Peter Brooke, Florence Cayouette, Cristelle Chow, José Colleti Junior, Conall Francoeur, Julia A. Heneghan, Yasser M. Kazzaz, Elizabeth Y. Killien, Supun Kotteduwa Jayawarden, Ruben Lasso, Laurie A. Lee, Aoife O'Mahony, Mallory A. PerryMiguel Rodríguez-Rubio, Ryan Sandarage, Hazel A. Smith, Alexandra Welten, Belinda Yee, Karen Choong, Brenda Morrow, Carrie Henderson, Fabrizio Chiusolo, Jan Hau Lee, Krista Wollny, Misty Pratt, Nicholas Bartel, Ryan Hirschfeld

Pediatric Critical Care Medicine

Research output: Contribution to journal › Review article › peer-review

21 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	E91-E103
Journal	Pediatric Critical Care Medicine
Volume	24
Issue number	2
DOIs	https://doi.org/10.1097/PCC.0000000000003125
State	Published - Feb 1 2023

Bibliographical note

Funding Information:
Dr. Zorko was supported by a Canadian Institutes of Health Research Canada Graduate Scholarship—Master’s Award. Dr. McNally disclosed that the code for the website used to crowdsource the systematic review is owned by a company called insightscope and that he worked with Algonquin College to develop the code and is the president of insightscope. Dr. Perry’s institution received funding from the National Institutes of Health and the American Association of Critical Care Nurses. Dr. Choong’s institution received funding from Alternative Funding Plan Innovation Fund Research Grant; she received funding from McMaster University. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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.

Keywords

chronic critical illness
chronic disease
critical care
intensive care units
pediatrics

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10.1097/PCC.0000000000003125

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Zorko, D. J., McNally, J. D., Rochwerg, B., Pinto, N., O'Hearn, K., Almazyad, M. A., Ames, S. G., Brooke, P., Cayouette, F., Chow, C., Junior, J. C., Francoeur, C., Heneghan, J. A., Kazzaz, Y. M., Killien, E. Y., Jayawarden, S. K., Lasso, R., Lee, L. A., O'Mahony, A., ... Hirschfeld, R. (2023). Defining Pediatric Chronic Critical Illness: A Scoping Review∗. Pediatric Critical Care Medicine, 24(2), E91-E103. https://doi.org/10.1097/PCC.0000000000003125

Zorko, DJ, McNally, JD, Rochwerg, B, Pinto, N, O'Hearn, K, Almazyad, MA, Ames, SG, Brooke, P, Cayouette, F, Chow, C, Junior, JC, Francoeur, C, Heneghan, JA, Kazzaz, YM, Killien, EY, Jayawarden, SK, Lasso, R, Lee, LA, O'Mahony, A, Perry, MA, Rodríguez-Rubio, M, Sandarage, R, Smith, HA, Welten, A, Yee, B, Choong, K, Morrow, B, Henderson, C, Chiusolo, F, Lee, JH, Wollny, K, Pratt, M, Bartel, N & Hirschfeld, R 2023, 'Defining Pediatric Chronic Critical Illness: A Scoping Review∗', Pediatric Critical Care Medicine, vol. 24, no. 2, pp. E91-E103. https://doi.org/10.1097/PCC.0000000000003125

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title = "Defining Pediatric Chronic Critical Illness: A Scoping Review∗",

abstract = "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.",

keywords = "chronic critical illness, chronic disease, critical care, intensive care units, pediatrics",

author = "Zorko, {David J.} and McNally, {James Dayre} and Bram Rochwerg and Neethi Pinto and Katie O'Hearn and Almazyad, {Mohammed A.} and Ames, {Stefanie G.} and Peter Brooke and Florence Cayouette and Cristelle Chow and Junior, {Jos{\'e} Colleti} and Conall Francoeur and Heneghan, {Julia A.} and Kazzaz, {Yasser M.} and Killien, {Elizabeth Y.} and Jayawarden, {Supun Kotteduwa} and Ruben Lasso and Lee, {Laurie A.} and Aoife O'Mahony and Perry, {Mallory A.} and Miguel Rodr{\'i}guez-Rubio and Ryan Sandarage and Smith, {Hazel A.} and Alexandra Welten and Belinda Yee and Karen Choong and Brenda Morrow and Carrie Henderson and Fabrizio Chiusolo and Lee, {Jan Hau} and Krista Wollny and Misty Pratt and Nicholas Bartel and Ryan Hirschfeld",

note = "Funding Information: Dr. Zorko was supported by a Canadian Institutes of Health Research Canada Graduate Scholarship—Master{\textquoteright}s Award. Dr. McNally disclosed that the code for the website used to crowdsource the systematic review is owned by a company called insightscope and that he worked with Algonquin College to develop the code and is the president of insightscope. Dr. Perry{\textquoteright}s institution received funding from the National Institutes of Health and the American Association of Critical Care Nurses. Dr. Choong{\textquoteright}s institution received funding from Alternative Funding Plan Innovation Fund Research Grant; she received funding from McMaster University. The remaining authors have disclosed that they do not have any potential conflicts of interest. Publisher Copyright: Copyright {\textcopyright} 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.",

year = "2023",

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doi = "10.1097/PCC.0000000000003125",

language = "English (US)",

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pages = "E91--E103",

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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 - Funding Information: Dr. Zorko was supported by a Canadian Institutes of Health Research Canada Graduate Scholarship—Master’s Award. Dr. McNally disclosed that the code for the website used to crowdsource the systematic review is owned by a company called insightscope and that he worked with Algonquin College to develop the code and is the president of insightscope. Dr. Perry’s institution received funding from the National Institutes of Health and the American Association of Critical Care Nurses. Dr. Choong’s institution received funding from Alternative Funding Plan Innovation Fund Research Grant; she received funding from McMaster University. The remaining authors have disclosed that they do not have any potential conflicts of interest. 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

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Defining Pediatric Chronic Critical Illness: A Scoping Review∗

Abstract

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