Maayke Hunfeld

12 Chapter 1 Score Category Description 1 Normal Normal; at age-appropriate level; 2 Mild disability Conscious, alert, and able to interact at age-appropriate level; school-age child attending regular school classroom, but grade perhaps not appropriate for age; possibility of mild neurologic deficit 3 Moderate disability Conscious; sufficient cerebral function for age-appropriate independent activities of daily life; school-age child attending special education classroom and/or learning deficit present. 4 Severe disability Conscious; dependent on others for daily support because of impaired brain function 5 Coma or vegetative state Any degree of coma without the presence of all brain death criteria; unaware, even if awake in appearance, without interaction with environment; cerebral unresponsiveness and no evidence of cortex function (not aroused by verbal stimuli); possibility of some reflexive response, spontaneous eye-opening, and sleep-wake cycles 6 Brain death Apnea, areflexia, and/or electroencephalographic silence Table 1. PCPC Score Besides physical outcome, other outcome domains also inform us about the outcome of a child: neurocognitive functioning, psychosocial functioning and quality of life. Table 2 gives an overview of literature on neuropsychological outcome after pediatric IHCA and OHCA published over the past 10 years. It illustrates the lack of studies on this topic. In a cross-sectional cohort of 47 children surviving CA in our hospital between 2002-2011 ( both IHCA and OHCA), with a median follow-up interval of 5.6 years (range 1.8-11.9 years), lower scores were found on all intelligence sub-scales. In addition, neuropsychological tests revealed lower scores on visual memory. Somewhat surprisingly, compared with norms, better scores were found on verbal memory (5). In this same cohort also long-term emotional and behavioral functioning of children was assessed with validated questionnaires for children, parents/caregivers and teachers (Youth Self-Report, Child Behavior Checklist and Teacher’s Report Form). In the reports of parents and teachers, deficits in attention and somatic complaints in children were reported (40). Additionally, long-term health status and health related quality of life was assessed. Parents reported poorer health status in their children (Health Utilities Index Mark). Health related quality of life (Child Health Questionnaire) was significantly worse on general health perception, physical role functioning, parental impact and overall physical summary . In contrast parents reported better family cohesion. Parents themselves scored better health related quality of life (quality of life of parents measured with 36 item Short Form Health Survey) on most scales (41).