Clinical factors associated with long-term recovery following pediatric critical illness and injury

与儿科危重疾病和损伤后长期康复相关的临床因素

• 批准号: 10388133
• 负责人: Elizabeth Y Killien
• 金额: $ 16.03万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-09 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10388133
• 关键词: Acute; Acute respiratory failure; Address; Admission activity; Adolescent; Affect; Award; Burn injury; Caring; Categories; Cause of Death; Cessation of life; Characteristics; Child; Child Health; Childhood; Childhood Injury; Clinical; Clinical Data; Clinical Management; Collaborations; Complement; Continuity of Patient Care; Critical Care; Critical Illness; Data; Database Management Systems; Deterioration; Development; Diagnosis; Ensure; Exposure to; Family; Functional disorder; Funding; Goals; Health; Health Status; Healthcare; Hospitals; Housing; Hypoxemia; Impaired health; Impairment; Injury; Intensive Care Units; Interdisciplinary Study; Intervention; Measures; Mechanical ventilation; Medical center; Medicine; Mental Health; Mentorship; Methodology; Morbidity - disease rate; Multicenter Studies; National Institute of Child Health and Human Development; Organ; Outcome; Outcome Assessment; Patients; Pediatric Hospitals; Pediatrics; Post-Traumatic Stress Disorders; Prevention Research; Prevention strategy; Process; Prospective Studies; Quality of life; Recovery; Research; Research Design; Research Personnel; Research Project Grants; Research Training; Risk; Schools; Sedation procedure; Sepsis; Series; Service delivery model; Severities; Shock; Statistical Methods; Survivors; Time; Training; Trauma; Trauma patient; Traumatic injury; United States; Universities; Washington; Work; career; cohort; experience; functional outcomes; functional status; health assessment; health related quality of life; improved; injury prevention; medical complication; mortality; pediatric trauma; primary endpoint; programs; psychosocial; recruit; severe injury; skills; treatment strategy; virtual

PROJECT SUMMARY/ABSTRACT As pediatric trauma mortality in the United States has declined over the past several decades, children are surviving after increasingly severe injuries. Many children surviving severe trauma experience prolonged impairments in quality of life, function, and psychosocial health. Existing studies have only evaluated how injury characteristics affect morbidity; it is unknown whether any modifiable factors influence long-term outcomes. Critically injured children often experience medical complications of their initial injury with prolonged treatment in the intensive care unit, and thus there may be components of their clinical course that contribute to morbidity beyond the effects of the injury alone. Identification of these clinical factors may provide targets for improvement in critical care management in order to optimize recovery from severe pediatric trauma. The long-term career goal of the K23 candidate, Elizabeth Killien, MD, MPH, is to build an independently funded research program to develop interventions to improve long-term outcomes among critically injured children. Her proposed research project will evaluate the contribution of a variety of clinical factors to long-term deterioration in health status after pediatric trauma. The specific aims are to 1) evaluate how the longitudinal trajectory of post-discharge recovery differs among children surviving critical injury compared to other acute illnesses; 2) determine which clinical exposures are associated with outcomes for trauma compared to other acute illnesses; and 3) assess the generalizability of the important clinical exposures identified locally in a multicenter national trauma cohort. These objectives are consistent with the priorities of the Pediatric Trauma and Critical Illness Branch of NICHD to conduct “multidisciplinary research across the continuum of care” to understand “the long-term impact of trauma on child health outcomes.” To acquire the skills necessary to accomplish this project and subsequently develop an R-series proposal, Dr. Killien will undertake didactic and experiential training to 1) develop expertise in multi- dimensional, longitudinal assessment of post-hospitalization outcomes; 2) gain experience with prospective study design and management and collaboration with research networks; 3) acquire skills in advanced statistical methods; and 4) facilitate her transition to independence. Dr. Killien has assembled an interdisciplinary mentorship and collaborator team with expertise in pediatric trauma, critical care, organ dysfunction, outcomes assessment, and statistical methodology to ensure completion of the proposed research and training and a successful transition to independence. Her research and training will be conducted at the University of Washington's Harborview Injury Prevention and Research Center. The proposed award will augment Dr. Killien's existing strengths in outcome assessment after critical illness and provide the additional training necessary for her to become an independent investigator in pediatric critical care medicine.

项目概要/摘要 随着美国儿科创伤死亡率在过去几十年中有所下降，儿童 在日益严重的伤害后幸存下来。许多幸存于严重创伤的儿童经历了长期的 生活质量、功能和心理健康受损。现有研究仅评估了损伤如何 特征影响发病率；目前尚不清楚是否有任何可改变的因素会影响长期结果。 严重受伤的儿童在长期治疗中常常会出现最初受伤时出现的医疗并发症 在重症监护室，因此其临床病程的某些组成部分可能会导致发病 超出了单独伤害的影响。这些临床因素的识别可以为治疗提供目标 改善重症监护管理，以优化严重儿科创伤的康复。 K23 候选人 Elizabeth Killien（医学博士、公共卫生硕士）的长期职业目标是建立一个 独立资助的研究计划，旨在制定干预措施，以改善长期结果 受重伤的儿童。她提出的研究项目将评估各种临床的贡献 儿科创伤后健康状况长期恶化的因素。具体目标是 1) 评估 重伤幸存儿童出院后恢复的纵向轨迹有何不同 与其他急性疾病相比； 2) 确定哪些临床暴露与结果相关 与其他急性疾病相比，创伤； 3) 评估重要临床暴露的普遍性 在多中心国家创伤队列中在当地发现。这些目标与优先事项是一致的 NICHD 儿科创伤和危重疾病科将开展“跨学科的多学科研究” 连续护理”来了解“创伤对儿童健康结果的长期影响”。 获得完成该项目所需的技能并随后开发 R 系列 根据提案，Killien 博士将进行教学和体验式培训，以 1) 发展多方面的专业知识 对出院后的结果进行维度、纵向的评估； 2）获得潜在经验 研究设计和管理以及与研究网络的合作； 3）获得高级技能 统计方法； 4) 帮助她过渡到独立。 Killien 博士收集了一个 跨学科指导和合作团队，拥有儿科创伤、重症监护、器官方面的专业知识 功能障碍、结果评估和统计方法，以确保完成拟议的 研究和培训以及成功过渡到独立。她的研究和培训将进行 华盛顿大学港景伤害预防和研究中心。拟议的奖项将 增强 Killien 博士在危重病后结果评估方面的现有优势，并提供额外的 她成为儿科重症监护医学独立研究者所必需的培训。