One-year neurological outcomes in critically ill children: prognostic value of the pediatric cerebral performance category score
DOI:
https://doi.org/10.18203/2349-3291.ijcp20262966Keywords:
PCPC score, PICU, PRISM III-24 scoreAbstract
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.
References
Fiser DH. Assessing the outcome of pediatric intensive care. J Pediatr. 1992;121(1):68-74.
Manning JC, Pinto NP, Rennick JE, Colville G, Curley MAQ. Conceptualizing post-intensive care syndrome in children-the PICS-p framework. Lancet Child Adolesc Health. 2018;2(6):421-33.
Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121-6.
Lwanga SK, Lemeshow S. Sample Size Determination in Health Studies: A Practical Manual. Geneva: World Health Organization; 1991. Available at: https://iris.who.int/items/9c2e5da4-3785-4fec-9dbc-841e4ae0d98c. Accessed on 14 May 2026.
Lubis AD, Nasution BB, Lubis AP, Supriami K. Role of pediatric risk of mortality (PRISM IV) score at 24 and 72 hours of hospitalization in predicting mortality among critically ill children treated in PICU. Narra J. 2024;4(2):e780.
Nishiyama M, Nagase H, Tanaka T, Fujita K, Kusumoto M, Kajihara S, et al. Neurological outcomes in children with suspected acute encephalopathy assessed using the Pediatric Cerebral Performance Category scale. Brain Dev. 2016;38(7):623-30.
Jones S, Rantell K, Stevens K, Fujita K, Kusumoto M, Kajihara S, et al. Outcome at 6 months after admission for paediatric intensive care: a national UK study. Pediatrics. 2006;118(5):2101-8.
Gatera R, Strelzer S, Mushimiyimana F, Nizeyimana F, Umuhoza C, Kanyamuhunga A, et al. Functional outcomes and clinical characteristics of children discharged from pediatric intensive care unit in a low- and middle-income country. J Pediatr Crit Care. 2024;11:200-7.
Butt W, Shann F, Tibballs J, Williams J, Cuddihy L, Blewett L, et al. Long-term outcome of children after intensive care. Crit Care Med. 1990;18:961-5.
Chaiyakulsil C. Post-intensive-care morbidity among pediatric children: prevalence, risk factors, and the importance of the post-intensive-care clinic in Thailand. Acute Crit Care. 2024:600-10.
Akande M, Paquette ET, Magee P, Perry-Eaddy MA, Fink EL, Slain KN. Screening for Social Determinants of Health in the Pediatric Intensive Care Unit: Recommendations for Clinicians. Crit Care Clin. 2023;39(2):341-55.
Edwards JD, Houtrow AJ, Vasilevskis EE, Rehm RS, Markovitz BP, Graham RJ, et al. Chronic conditions among children admitted to Paediatric intensive care units: prevalence and impact. Crit Care Med. 2012;40:2196-203.
Feudtner C, Christakis DA, Connell FA. Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980-1997. Pediatrics. 2000;106:205-9.
Gulla KM, Sachdev A. Illness severity and organ dysfunction scoring in pediatric intensive care unit. Indian J Crit Care Med. 2016;20:1-6.
Caprarola SD, Kudchadkar SR, Bembea MM. Neurologic outcomes following care in the Paediatric Intensive Care Unit. Curr Treat Options Paediatr. 2017;3:193-207.
Sankar J, Moodu S, Lodha R. Functional outcomes at 1 year after PICU discharge in critically ill children with severe sepsis. Pediatr Crit Care Med. 2021;22:248.
Lee EP, Chan OW, Lin JJ, Hsia SH, Wu HP. Risk factors and neurologic outcomes associated with resuscitation in the Paediatric intensive care unit. Front Pediatr. 2022;10:834746.
Tilford JM, Simpson PM, Green JW, Lensing S, Fiser DH. Volume-outcome relationships in Paediatric intensive care units. Pediatrics. 2000;106:289-94.
Slater A, Shann F. The suitability of the Paediatric Index of Mortality (PIM), PIM2, the Paediatric Risk of Mortality (PRISM), and PRISM III for monitoring the quality of Paediatric intensive care in Australia and New Zealand. Paediatr Crit Care Med. 2004;5:447-54.
Gemke RJ, Bonsel GJ, van Vught AJ. Long-term survival and state of health after Paediatric intensive care. Arch Dis Child. 1995;73:196-201.
Wilson NE, Su F, DaCar A, Chang N, Kapphahn K, Schroeder AR, et al. Performance of a provider-assigned functional outcome score in critically ill children. Pediatr Crit Care Med. 2023;24(10):e447-5.
Ambuehl J, Karrer A, Meer A, Riedel T, Schibler A. Quality of life of survivors of paediatric intensive care. Swiss Med Wkly. 2007;137(21-22):312-6.
Taylor A, Butt W, Giardulli M. Functional outcome and quality of life after ICU admission. Intensive Care Med. 2003;29:795-800.
Seferian EG, Carson SS, Pohlman A, Hall J. Comparison of resource utilization and outcomes between Paediatric and adult ICU children. Paediatr Crit Care Med. 2001;2:2-8.
Downloads
Published
How to Cite
Issue
Section
