Changes in Academic Standardized Testing After Pediatric Intensive Care

Importance: Children who survive critical illness commonly experience long-term morbidities. Little is known about the association of critical illness with cognitive health due to lack of preillness and postillness assessments and an adequate comparison population. Objective: To use school-based testing to evaluate cognitive health outcomes among children treated in the pediatric intensive care unit (PICU) compared with non-PICU-exposed control students. Design, Setting, and Participants: This retrospective case-control study used statewide academic data and propensity score matching of 1088 patients admitted to the only PICU in Arkansas from January 1, 2008, to December 31, 2018, as well as controls matched on sociodemographic and pre-PICU admission academic factors. Statistical analysis was performed from March 2024 to September 2025. Exposure: PICU admission. Main Outcomes and Measures: Primary outcomes were (1) return to standardized testing, assessed using multivariable logistic regression to assess the odds of having a standardized test within 2 years after PICU admission compared with controls, and (2) change in pre-PICU to post-PICU test scores for PICU patients compared with propensity-matched control students, assessed using multivariable linear regression. Results: In this case-control study of 1088 school-aged patients (mean [SD] age, 12.1 [1.6] years; 566 girls [52.0%]), fewer PICU patients than controls had test scores after admission for math (80.6% [874 of 1085] vs 86.5% [938 of 1085]; adjusted odds ratio [AOR], 0.64 [95% CI, 0.51-0.81]) and reading (81.1% [877 of 1081] vs 87.1% [941 of 1081]; AOR, 0.64 [95% CI, 0.51-0.82]). PICU patients' preadmission z scores were below average in math (z = -0.23 [95% CI, -0.29 to -0.16]) and reading (z = -0.22 [95% CI, -0.29 to -0.15]) compared with Arkansas students in the same grade and year. In adjusted pre-post analyses, PICU patients had a small but significant decrease in reading relative to controls (-0.07 [95% CI, -0.14 to -0.01]). The change in math score was not statistically significant (-0.06 [95% CI, -0.13 to 0.003]). Conclusions and Relevance: This study suggests that PICU patients were less likely to take standardized tests after discharge and that those who did had greater decreases in reading scores relative to matched controls. Future studies should identify risk factors for nonreturn to testing and score decrease.