Pediatric Chronic Critical Illness: Protocol for a Scoping Review.

David Zorko,Rachel Couban,Bram Rochwerg,Katie O'Hearn,Neethi Pinto,James Dayre Mcnally,Karen Choong

doi:10.2196/30582

Abstract

BackgroundImprovements in the delivery of intensive care have increased survival among even the most critically ill children, thereby leading to a growing number of children with chronic complex medical conditions in the pediatric intensive care unit (PICU). Some of these children are at a significant risk of recurrent and prolonged critical illness, with higher morbidity and mortality, making them a unique population described as having chronic critical illness (CCI). To date, pediatric CCI has been understudied and lacks an accepted consensus case definition.ObjectiveThis study aims to describe the protocol and methodology used to perform a scoping review that will describe how pediatric CCI has been defined in the literature, including the concept of prolonged PICU admission and the methodologies used to develop any existing definitions. It also aims to describe patient characteristics and outcomes evaluated in the included studies.MethodsWe will search four electronic databases for studies that evaluated children admitted to any PICU identified with CCI. We will also search for studies describing prolonged PICU admission, as this concept is related to pediatric CCI. Furthermore, we will develop a hybrid crowdsourcing and machine learning (ML) methodology to complete citation screening. Screening and data abstraction will be performed by 2 reviewers independently and in duplicate. Data abstraction will include the details of population definitions, demographic and clinical characteristics of children with CCI, and evaluated outcomes.ResultsThe database search, crowd reviewer recruitment, and ML algorithm development began in March 2021. Citation screening and data abstraction were completed in April 2021. Final data verification is ongoing, with analysis and results anticipated to be completed by fall 2021.ConclusionsThis scoping review will describe the existing or suggested definitions of pediatric CCI and important demographic and clinical characteristics of patients to whom these definitions have been applied. This review’s results will help inform the development of a consensus case definition for pediatric CCI and set a priority agenda for future research. We will use and demonstrate the validity of crowdsourcing and ML methodologies for improving the efficiency of large scoping reviews.International Registered Report Identifier (IRRID)DERR1-10.2196/30582

Highlights

We will search for studies describing prolonged pediatric intensive care unit (PICU) admission, as this concept is related to pediatric critical illness (CCI)
The limitations of the nature and extent of populations and outcomes evaluated in current pediatric CCI research will be addressed in the Discussion section of the paper
This scoping review is the first phase of a larger research program to systematically evaluate children with CCI. This scoping review is the first evidence synthesis to provide a systematic overview of the definitions used in the literature for identifying children with CCI and prolonged PICU admission

Summary

Introduction

Improvements in the delivery of intensive care have increased survival among even the most critically ill children, thereby leading to a growing number of children with chronic complex medical conditions in the pediatric intensive care unit (PICU) Some of these children are at a significant risk of recurrent and prolonged critical illness, with higher morbidity and mortality, making them a unique population described as having chronic critical illness (CCI). There is a growing recognition that a subset of pediatric critical illness survivors experience persistent multiorgan system dysfunction and functional morbidities following critical illness that subsequently render them with either a prolonged need for critical care support as inpatients or dependence on medical technology to be cared for as outpatients [5,6,7,8] These children are increasingly recognized as a uniquely high-risk PICU population, referred to as children with chronic critical illness (CCI) [4,6]. Is it possible to determine modifiable risk factors for poor patient outcomes, and develop and evaluate interventions to improve the care and survivorship of this important PICU patient population

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