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: 10609851
• 负责人: Elizabeth Y Killien
• 金额: $ 15.99万
• 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 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10609851
• 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; Dimensions; Ensure; Exposure to; Family; Functional disorder; Funding; Goals; Health; Health Status; Healthcare; Hospitalization; Hospitals; Housing; Hypoxemia; Impaired health; Impairment; Injury; Intensive Care Units; Interdisciplinary Study; Intervention; Managed Care; 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 strategy; Process; Prospective Studies; Quality of life; Recovery; Research; Research Design; Research Personnel; Research Project Grants; 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; long term recovery; medical complication; mortality; pediatric trauma; primary endpoint; programs; psychosocial; recruit; severe injury; skill acquisition; 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.

项目摘要/摘要 由于过去几十年来，随着美国的小儿创伤死亡率下降，儿童 受伤日益严重后的生存。许多孩子幸存的严重创伤经历延长了 生活质量，功能和社会心理健康的损害。现有研究只评估了伤害 特征会影响发病率；尚不清楚任何可修改因素是否影响长期结局。 受伤的儿童经常经常因长时间治疗而受到最初受伤的医疗并发症 在重症监护室中，因此他们的临床过程可能有促进发病率的组成部分 仅仅是伤害的影响。这些临床因素的识别可能会为 重症监护管理的改善，以优化从严重的小儿创伤中恢复。 K23候选人伊丽莎白·基里恩（Elizabeth Killien），MD，MPH的长期职业目标是建造一个 独立资助的研究计划，以制定干预措施，以改善长期结果 重伤的孩子。她提出的研究项目将评估各种临床的贡献 小儿创伤后长期确定健康状况的因素。具体目的是1）评估 在严重伤害的儿童中，入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有关 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本地确定。这些目标与 NICHD的小儿创伤和重症疾病分支“ 持续护理”，以了解“创伤对儿童健康成果的长期影响”。 获取完成该项目所需的技能并随后开发R系列 提案，Killien博士将接受教学和专家培训1） 院后结果的维度，纵向评估； 2）获得潜在的经验 与研究网络的研究设计和管理以及合作； 3）获得高级技能 统计方法； 4）促进她向独立过渡。基里安博士聚集了 跨学科的心态和合作者团队具有儿科创伤，重症监护，器官专业知识 功能障碍，结果评估和统计方法，以确保完成建议 研究和培训以及成功过渡到独立性。她的研究和培训将进行 在华盛顿大学港口景观预防与研究中心。拟议的裁决将 增强基里安博士在重症病后的结果评估中的现有优势，并提供额外的 她成为小儿重症监护医学的独立研究者所需的培训。