Alterações da funcionalidade em crianças e adolescentes vítimas de trauma internadas em unidade de terapia intensiva pediátrica

Abstract

Introduction: Among the major causes of admission to the Intensive Care Unit (ICU) and morbimortality in children, traumas resulting from accidents and violence have stood out. In addition to the risks of sequelae from trauma, hospitalization processes and more invasive interventions in the ICU, such as mechanical ventilation and the use of sedoanalgesics, can be degrading factors for functionality. Objective: Compare the levels of functional status dysfunction of children who are victims of trauma admitted to the Pediatric ICU from admission to hospital discharge. Methods: This is an analytical, prospective cohort study of child and adolescent trauma victims of both genders, aged 29 days to 18 incomplete years. The investigation of functional changes was performed on admission, discharge from the ICU and hospital discharge using the Functional Status Scale (FSS) scores, which is composed of six domains: mental state, sensorial, communication, motor function, eating and breathing. To compare the frequency of categorical variables for moments of functionality assessment, Cochran's Q test was used, and Friedman's test was used to establish the difference in FSS score over time, adopting significance level of p < 0.05. The statistical treatment was carried out through the Statistical Package for the Social Sciences, version 21.0. Results: Pairwise comparisons showed that the FSS data from admission were different from all other times during hospitalization (p < 0.001), showing a change in the children's functional level after trauma to moderate/very severe. Twenty-three percent of the patients maintained a moderate/very severe level of dysfunction at hospital discharge. The motor domain presented a higher frequency of functional alterations in ICU discharge and hospital discharge. Conclusion: The functional evolution in pediatric trauma patients admitted to the ICU presents favorable outcomes, with potential recovery of functional status at hospital discharge in most of the studied population. However, a representative sample of previously healthy children has their functional status changed to moderate/very severe dysfunction after hospital discharge, with the motor domain being the most impaired.