• David J Zorko, James Dayre McNally, Bram Rochwerg, Neethi Pinto, Katie O'Hearn, Mohammed A Almazyad, Stefanie G Ames, Peter Brooke, Florence Cayouette, Cristelle Chow, JuniorJosé ColletiJCDepartment of Pediatrics, Hospital Assunção Rede D'Or, São Bernardo do Campo, São Paulo, Brazil., Conall Francoeur, Julia A Heneghan, Yasser M Kazzaz, Elizabeth Y Killien, JayawardenSupun KotteduwaSKFaculty of Medicine, University of British Columbia, Vancouver, BC, Canada., Ruben Lasso, Laurie A Lee, Aoife O'Mahony, Mallory A Perry, Miguel Rodríguez-Rubio, Ryan Sandarage, Hazel A Smith, Alexandra Welten, Belinda Yee, Karen Choong, International Pediatric Chronic Critical Illness Collaborative, Members of the International Pediatric Chronic Critical Illness Collaborative:, and International Pediatric Chronic Critical Illness Collaborative and Members of the International Pediatric Chronic Critical Illness Collaborative:.
• Department of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
• Pediatr Crit Care Me. 2023 Feb 1; 24 (2): e91e103e91-e103.

ObjectivesChildren with chronic critical illness (CCI) are hypothesized to be a high-risk patient population with persistent multiple organ dysfunction and functional morbidities resulting in recurrent or prolonged critical care; however, it is unclear how CCI should be defined. The aim of this scoping review was to evaluate the existing literature for case definitions of pediatric CCI and case definitions of prolonged PICU admission and to explore the methodologies used to derive these definitions.Data SourcesFour electronic databases (Ovid Medline, Embase, CINAHL, and Web of Science) from inception to March 3, 2021.Study SelectionWe included studies that provided a specific case definition for CCI or prolonged PICU admission. Crowdsourcing was used to screen citations independently and in duplicate. A machine-learning algorithm was developed and validated using 6,284 citations assessed in duplicate by trained crowd reviewers. A hybrid of crowdsourcing and machine-learning methods was used to complete the remaining citation screening.Data ExtractionWe extracted details of case definitions, study demographics, participant characteristics, and outcomes assessed.Data SynthesisSixty-seven studies were included. Twelve studies (18%) provided a definition for CCI that included concepts of PICU length of stay (n = 12), medical complexity or chronic conditions (n = 9), recurrent admissions (n = 9), technology dependence (n = 5), and uncertain prognosis (n = 1). Definitions were commonly referenced from another source (n = 6) or opinion-based (n = 5). The remaining 55 studies (82%) provided a definition for prolonged PICU admission, most frequently greater than or equal to 14 (n = 11) or greater than or equal to 28 days (n = 10). Most of these definitions were derived by investigator opinion (n = 24) or statistical method (n = 18).ConclusionsPediatric CCI has been variably defined with regard to the concepts of patient complexity and chronicity of critical illness. A consensus definition is needed to advance this emerging and important area of pediatric critical care research.Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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