Impaired mobility associated with an increased likelihood of death in children: a systematic review

Improved identification of children with increased likelihood of death can support appropriate provision of integrated palliative care; this systematic review aims to consider immobility and the associated likelihood of death, in children with disabilities, living in high-income countries. Two reviewers independently searched Medline, Embase, Cochrane Library, OpenGrey, Science Citation Index (1990 to 2016) for studies that reported hazard ratios (HR) and relative risk (RR) for likelihood of death related to impaired mobility. Nine papers were included. Three studies reported functioning using the Gross Motor Function Classification Scale (GMFCS); remaining studies reported measures of functioning unique to the study. The strongest single prognostic factor for likelihood of death was ‘lack of sitting ability at 24 months’, HR 44.4 (CI 6.1 to 320.8) followed by GMFCS V HR 16.3 (CI5.6 to 47.2) and 11.4 (CI 3.76 to 35.57) and ‘not able to cruise by 24 months’ HR 14.4 (CI 3.5 to 59.2). Immobility is associated with increased risk of dying over study periods, but different referent groups make clinical interpretation challenging; overall, quality of evidence is moderate. The findings suggest that immobility can indicate suitability for integrated palliative care, for children with disabilities.