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

Abstract

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.