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

项目摘要/摘要 随着美国儿科创伤死亡率在过去几十年里有所下降，儿童 在日益严重的伤势中幸存下来。许多在严重创伤中幸存下来的儿童经历了漫长的经历 生活质量、功能和心理社会健康方面的损害。现有的研究只评估了伤害如何 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果。 严重受伤的儿童在长期治疗的情况下，往往会在最初受伤时出现医疗并发症 在重症监护病房，因此他们的临床病程中可能有导致发病率的部分 除了受伤本身的影响之外。识别这些临床因素可能会为 改善重症监护管理，以优化儿科严重创伤的康复。 K23候选人，医学博士，公共卫生硕士伊丽莎白·基利安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 受重伤的儿童。她提出的研究项目将评估各种临床研究的贡献 儿科创伤后健康状况长期恶化的因素。具体目标是：1)评估 危重伤者出院后恢复的纵向轨迹有何不同 与其他急性疾病进行比较；2)确定哪些临床暴露与 创伤与其他急性疾病的比较；以及3)评估重要临床暴露的概括性 在多中心国家创伤队列中被当地确认。这些目标与以下优先事项一致 NICHD的儿科创伤和危重病分部将进行“多学科研究” 理解创伤对儿童健康结果的长期影响的连续护理。 获取完成此项目并随后开发R系列所需的技能 计划中，Killien博士将进行授课和经验式培训，以1)发展多方面的专业知识 住院后结果的维度、纵向评估；2)获得预期的经验 研究设计和管理以及与研究网络的合作；3)掌握高级技能 统计方法；4)促进她向独立的过渡。基利安博士已经组装了一个 具有儿科创伤、重症监护、器官等方面专业知识的跨学科指导和协作团队 功能障碍、结果评估和统计方法，以确保完成拟议的 研究和培训以及向独立的成功过渡。她的研究和培训将进行 在华盛顿大学的港景伤害预防和研究中心。拟议的奖励将 增强Killien博士在危重疾病后结果评估方面的现有优势，并提供更多 她需要接受必要的培训，才能成为儿科重症监护医学的独立研究员。

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.