Functional Recovery in Critically ill Children, the “WeeCover” multi-centre Study. Clinicaltrials.gov NCT02148081
Women and Children
Innovation: The Wee-cover Multi-center study is the first longitudinal, mixed methods prospective study to provide key epidemiological data on functional and overall health outcomes for children and families after survival from a critical illness.
Adoptability: We are currently the only group conducting outcomes based and rehabilitation research on critically ill adults and children in Canada, and are leading this field of research globally. Our results will be generalizable to Pediatric Intensive Care Units (PICU’s) across Canada, and we are collaborating with international networks interested in expanding this research to their countries.
Outcomes: Our results justify the need to modify predictors of poor recovery, develop best practice recommendations for quality improvement, and develop sustainable follow-up programmes to evaluate, monitor and maintain the long-term health of survivors and families of our sickest children, that currently do not exist.
Transformation: Rehabilitation is an expectation for critically ill children, yet there are no pediatric specific guidelines. Such data are required to inform whether post-PICU follow-up and rehabilitation programs are necessary for critically ill children, as have been established for critically ill neonates and adults.
The WeeCover study is a longitudinal, mixed methods multi-center prospective cohort study, embedded within a larger multiphase program of research on acute rehabilitation in critically ill children. The objectives are to: 1) measure functional recovery and predictors of poor functional recovery in critically ill children, and 2) determine the extent to which we are measuring recovery from a patient oriented perspective, using qualitative methods.
Methods: children aged over 12 months to 17 years, with at least one organ dysfunction and a minimum Pediatric Intensive Care Units (PICUs) length of stay of 48 hours were enrolled. The primary outcome is functional recovery 6 months post-PICU discharge. Secondary outcomes include caregiver burden, health care utilization, PICU-acquired morbidities, and 6 month mortality; patient centered outcomes were evaluated using qualitative methods.
Preliminary Results: We enrolled 180 patients between August 2014 to January 2016. To date, the 3 and 6 month follow-up rates are 87% and 90% respectively. Six-month follow-up will be completed by August 2016. The mean age of participants is 9 years (SD 5.5), and 54% were males. On admission, 68% had a pre-existing chronic condition, and 51% had some baseline functional limitation. Functional outcomes and predictors of poor functional recovery will be analyzed upon completion of follow-up, and what defines functional recovery will be supported by qualitative data (analysis in progress).
Conclusion: This research is essential to our understanding of critical illness sequelae and long-term outcomes in children, and is an essential pre-requisite for evaluating early rehabilitation interventions to enhance recovery in critically ill children, and supportive programs following PICU discharge.