(338) Post-Intensive Care Syndrome in Children: A Descriptive Study of Deficits After Brain Injury

Introduction: Children with acquired brain injury often require intensive rehabilitation and demonstrate persistent deficits. Literature exists describing Post-Intensive Care Syndrome (PICS) development in adult ICU survivors. However, more information is needed regarding these symptoms in children and how to predict those most at risk.

Methods: Retrospective analysis of all patients admitted to a children’s hospital for moderate/severe acquired brain injury that followed-up in a dedicated multi-disciplinary brain injury clinic from Jul 2023-Apr 2024. Patients with an unfavorable Pediatric Cerebral Performance Category (PCPC) (score 3-6 and decline from baseline) were compared to those with a favorable PCPC at discharge. Differences in baseline characteristics and exposures were assessed as were outcome measures at clinic follow-up, including Functional Status Scale (FSS), Pediatric Abilities and Mobility Scale (PAMS) and further descriptive characteristics of deficits.

Results: Of 25 patients, 11 had an unfavorable PCPC at discharge and 1 had an unfavorable PCPC at follow-up. Longer ICU stay, days on mechanical ventilation, and days on sedation infusions were associated with unfavorable PCPC at discharge (p < 0.001). Fifty two percent of patients experienced delirium and 40% discharged to an inpatient rehabilitation facility. Median [IQR] time to follow-up was 0.2 years [0.1, 1.2]. Unfavorable PCPC at discharge was associated with more deficits in clinic demonstrated in both FSS (median [IQR]: 10 [9.5, 11] vs 8 [7,9], p=0.004) and PAMS (92 [83, 98] vs 99 [96,100], p=0.026). For patients with a PCPC of 2 at follow-up, PAMS ranged from 59-97 and FSS from 10-14. While 96% of patients had a favorable PCPC at follow-up, 28% carried a new mental health diagnosis, 20% had sleep disturbances, 56% had abnormal strength, 68% had abnormal vision, and 40% had abnormal coordination.

Conclusions: Pediatric patients with severe brain injury are more likely to have functional deficits at follow-up. However, even those with a considerably “favorable” recovery continue to have deficits, including mental health diagnoses and persistent functional deficits, consistent with PICS. These require more granular screening tools and standardized follow-up.