Publication:

One-year neurological outcomes in critically ill children: prognostic value of the pediatric cerebral performance category score

Background Improved pediatric intensive care survival leaves many with long-term neurological impairments, highlighting the need for simple, reliable tools to monitor post-discharge functional outcomes. Objective of the study was to evaluate the utility of the pediatric cerebral performance category (PCPC) score in assessing neurological outcomes and predicting long-term prognosis among children admitted to the pediatric intensive care unit (PICU).

Methods This prospective cohort study was conducted in the PICU of a tertiary care hospital and included 150 children aged 40 days to 14 years. Baseline demographic, clinical characteristics and pediatric risk of mortality (PRISM III-24) scores were recorded. Neurological outcome was assessed using the PCPC score at admission, discharge and follow-up over a period of one year. Risk factors were analyzed using multivariate logistic regression.

Results Respiratory infection was the commonest indication for PICU admission. Neurological status deteriorated during critical illness with the proportion of children having normal neurological function decreasing from 72.0% before illness to 28.0% at discharge. Higher PRISM III-24 scores were associated with increased mortality and poorer neurological outcomes. Baseline neurological impairment, prolonged mechanical ventilation, seizures, cardiopulmonary resuscitation, central nervous system infections, and a discharge PCPC score ≥4 were significant predictors of adverse outcomes. Twelve children died during the study period. A discharge PCPC score ≥4 predicted poor neurological outcome at 12 months with a sensitivity of 75.0%, specificity of 84.9%, and AUC of 0.86 (95% CI 0.79-0.93).

Conclusions The PCPC score is a simplest and reliable clinical tool for evaluating neurological progression and predicting long-term prognosis in critically ill children.