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

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.