Follow-up after PICU discharge for patients with acquired brain injury: the role of an abbreviated neuropsychological evaluation and a return-to-school program

• Published in: Pediatric critical care medicine Vol. 24; no. 10; pp. 807 - 817
• Main Authors: Williams, Cydni N, Hall, Trevor A, Baker, Victoria A, Chertow, Daniel J, Vanderlind, W Michael, Bosworth, Christopher C, Hartman, Mary E
• Format: Journal Article
• Language: English
• Published: United States 01-10-2023
• Subjects: Aftercare; Brain Injuries - complications; Brain Injuries - diagnosis; Child; Child, Preschool; Follow-Up Studies; Humans; Intensive Care Units, Pediatric; Patient Discharge; Retrospective Studies; Return to School; educational intervention; neuropsychology; recovery; neurocognitive testing; Pediatric Critical Care; school
• DOI: 10.1097/PCC.0000000000003303
• ISSN: 1529-7535

To present the results of an abbreviated testing protocol used to screen for neurocognitive and psychological sequelae of critical illness among pediatric intensive care unit (PICU) survivors with acquired brain injury in our post-discharge follow-up programs, and describe our process for facilitating this population's return to academic life.
Retrospective cohort study.
Neurocritical care follow-up programs at two U.S. academic, tertiary medical/surgical PICUs.
Children age > 4 years enrolled in the neurocritical care follow-up programs (n=289) at these institutions who underwent neurocognitive and psychological testing between 2017-2021.
None.
One month after discharge from the hospital, nearly half of the children and/or their parents (48%) in our neurocritical care follow-up programs identified some type of emotional or behavioral concern compared to their premorbid state, and 15% reported some type of cognitive concern. On evaluation, 35% of the children were given a new neurocognitive diagnosis. Neurocognitive domains regulated by the executive functioning system were the most commonly affected, including attention (54%), memory (31%) and processing speed (27%). One-quarter of the children were given a new psychological diagnosis, most commonly post-traumatic stress disorder (PTSD) or stress-related symptoms (12%). Over 80% of patients in the programs were given new recommendations for school, for both new academic services and new classroom accommodations. Over half of children (57%) were referred for comprehensive follow-up neuropsychological evaluation.
Abbreviated neurocognitive and psychological evaluation successfully identifies the same deficits commonly found among PICU survivors who undergo longer, more complete testing protocols. When combined with services aimed at successfully re-integrating PICU survivors back to school, this focused evaluation can provide an effective and efficient means of screening for cognitive and emotional deficits among PICU survivors, and establish a rationale for early academic support upon the child's return to school.