Function in the first year after paediatric critical illness- a systematic review and meta-analysis
Bibliographic record
Abstract
Abstract Objective To describe function up to 12-months after critical illness with an overall prognosis systematic review and meta-analysis. Data sources We searched MEDLINE, Cochrane and Embase on May 10, 2021. Study selection Cohorts and trials, published after 1994, in English, describing function after discharge and within 12-months of critical illness were independently assessed by two reviewers. Data extraction The 163 included publications described function in 15 662 children from 114 studied cohorts. Following the PRISMA guidelines, data extraction, risk of bias and GRADE assessments were independently performed by two physician reviewers. Our primary outcomes were overall, cognitive, physical, and socioemotional function after critical illness. Function was reported as raw data or categorized as normal, independent, mild to moderate impairment, moderate impairment, severe impairment, or death. Independent functioning included normal and mild to moderate impairment. Function was reported at baseline (before ICU), discharge, < 6 months, 6-months, and 12-months after critical illness. Random-effects proportional meta-analyses were used to calculate proportions at specified time periods. Mixed-effects logistic regression models were used to compare function using discharge as the reference. Data synthesis The most frequent diagnoses were cardiac arrest (CPA) and traumatic brain injury (TBI). At discharge independent overall functioning in patients with CPA was less frequent than at baseline, and remained similar 12 months later. Compared with discharge the Odds Ratio (95% CI, p-value) of independent overall function at baseline was 25.3 (2.3–121, p = 0.007) and was 0.75 (0.43–1.33, p = 0.2) at 12-months with a pooled percentage (95% CI) of independent function of 22 (11- 37)% at 12 months. Independent overall functioning in patients with TBI improved from discharge to 12-months. Compared with discharge the Odds Ratio (95% CI, p-value) of independent overall function at 6 months was 1.8 (1.4–2.4, p = 0.003) and was 1.6 (1.1–2.4), p = 0.03 at 12-months with a pooled percentage (95% CI) of independent function of 67 (53–78)% at 12 months. Conclusions Paediatric critical illness is associated with population-specific acquired functional impairment disability and variable recovery of function. These findings can help inform prognostication discussions and provide rationale for follow up and support programs for survivors of critical illness.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.035 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.022 | 0.039 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".