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

项目总结/摘要 随着美国儿科创伤死亡率在过去几十年中的下降， 在越来越严重的伤害后幸存下来。许多在严重创伤中幸存下来的儿童 生活质量、功能和心理健康受损。现有的研究仅评估了 特征影响发病率;尚不清楚是否有任何可改变的因素影响长期结局。 严重受伤的儿童往往会遇到医疗并发症的初步伤害与长期治疗 在重症监护室，因此可能存在导致发病的临床过程的组成部分 不仅仅是受伤的影响这些临床因素的识别可能为 改善重症监护管理，以优化严重儿科创伤的恢复。 K23候选人Elizabeth Killien，MD，MPH的长期职业目标是建立一个 独立资助的研究计划，以制定干预措施，以改善长期结果， 严重受伤的孩子。她提出的研究项目将评估各种临床 儿童创伤后健康状况长期恶化的因素。具体目标是：（1）评估 严重创伤幸存儿童出院后恢复的纵向轨迹如何不同 与其他急性疾病相比; 2）确定哪些临床暴露与以下结果相关： 与其他急性疾病相比，创伤;以及3）评估重要临床暴露的普遍性 在多中心国家创伤队列中发现。这些目标与下列优先事项一致： NICHD的儿科创伤和危重病分支进行“跨学科研究， 持续护理”，以了解“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 建议，Killien博士将进行教学和体验培训，以1）发展多方面的专业知识， 对住院后结局进行多维纵向评估; 2）获得前瞻性 研究设计和管理以及与研究网络的合作; 3）获得高级技能 （4）促进其向独立的过渡。基林博士已经组织了一个 具有儿科创伤、重症监护、器官移植、 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。她的研究和培训将由 在华盛顿大学的Harborview伤害预防和研究中心。该奖项将 增强Killien博士在危重病后结局评估方面的现有优势，并提供额外的 为她成为儿科重症监护医学的独立研究者所需的培训。

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.