Early Protocolized Versus Usual Care Rehabilitation for Pediatric Neurocritical Care Patients: A Randomized Controlled Trial. Issue 6 (June 2019)

• Record Type: Journal Article
• Authors: Fink, Ericka L.; Beers, Sue R.; Houtrow, Amy J.; Richichi, Rudolph; Burns, Cheryl; Doughty, Lesley; Ortiz-Aguayo, Roberto; Madurski, Catherine A.; Valenta, Cynthia; Chrisman, Maddie; Golightly, Lynn; Kiger, Michelle; Patrick, Cheryl; Treble-Barna, Amery; Pollon, Dorothy; Smith, Craig M.; Kochanek, Patrick
• Is Part Of: Pediatric critical care medicine. Volume 20:Issue 6(2019)
• Publication Date: 2019-06
• Subjects: critical care -- neurologic disorders -- outcome -- pediatric -- rehabilitation; Pediatric intensive care -- Periodicals; Pediatric emergencies -- Periodicals; 618.05
• DOI: 10.1097/PCC.0000000000001881
• Languages: English
• ISSNs: 1529-7535

Abstract

Abstract : Objective: s: Few feasibility, safety, and efficacy data exist regarding ICU-based rehabilitative services for children. We hypothesized that early protocolized assessment and therapy would be feasible and safe versus usual care in pediatric neurocritical care patients. Design: Randomized controlled trial. Setting: Three tertiary care PICUs in the United States. Patients: Fifty-eight children between the ages of 3–17 years with new traumatic or nontraumatic brain insult and expected ICU admission greater than 48 hours. Interventions: Early protocolized (consultation of physical therapy, occupational therapy, and speech and language therapy within 72 hr ICU admission, n = 26) or usual care (consultation per treating team, n = 32). Measurements and Main Results: Primary outcomes were consultation timing, treatment type, and frequency of deferrals and safety events. Secondary outcomes included patient and family functional and quality of life outcomes at 6 months. Comparing early protocolized ( n = 26) and usual care groups ( n = 32), physical therapy was consulted during the hospital admission in 26 of 26 versus 28 of 32 subjects ( p = 0.062) on day 2.4 ± 0.8 versus 7.7 ± 4.8 ( p = 0.001); occupational therapy in 26 of 26 versus 23 of 32 ( p = 0.003), on day 2.3 ± 0.6 versus 6.9 ± 4.8 ( p = 0.001); and speech and language therapy in 26 of 26 versus 17 of 32 ( p = 0.011) on day 2.3 ± 0.7 versus 13.0 ± 10.8 ( p = 0.026). More children in the early protocolized group had consults and treatments occur in the ICU versus ward for all three services (all p < 0.001). Eleven sessions were discontinued early: nine during physical therapy and two during occupational therapy, none impacting patient outcome. There were no group differences in functional or quality of life outcomes. Conclusions: A protocol for early personalized rehabilitation by physical therapy, occupational therapy, and speech and language therapy in pediatric neurocritical care patients could be safely implemented and led to more ICU-based treatment sessions, accelerating the temporal profile and changing composition of interventions versus usual care, but not altering the total dose of rehabilitation. Abstract : Supplemental Digital Content is available in the text.