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Wu PC, Tsai SJ, Bai YM, Hsu JW, Su TP, Chen TJ, Chen MH. Risks of developing major psychiatric disorders among child and adolescent intensive care unit survivors. J Affect Disord 2024; 362:772-778. [PMID: 39032708 DOI: 10.1016/j.jad.2024.07.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/25/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The mental health of child and adolescent intensive care unit (ICU) survivors is increasingly being researched. However, the literature on how various types of critical illness influence specific psychiatric disorders remains limited. METHODS This study analyzed the data of 8704 child and adolescent ICU survivors and 87,040 age-, sex-, family income-, and residence-matched controls who were followed from enrollment to the end of 2013; the data covered the period from 1996 to 2013 and were extracted from a nationwide data set. The primary outcomes were the risks of five major psychiatric disorders (MPDs), namely schizophrenia, bipolar disorder (BD), major depressive disorder (MDD), obsessive compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). RESULTS Relative to the controls, the child and adolescent ICU survivors (mean age = 10.33 years) exhibited higher risks of developing five MPDs. The associated hazard ratios (HRs) and confidence intervals (CIs) are as follows: PTSD, HR = 4.67, 95 % CI = 2.42-9.01; schizophrenia, HR = 3.19, 95 % CI = 2.27-4.47; BD, HR = 2.02, 95 % CI = 1.33-3.05; OCD, HR = 1.96, 95 % CI = 1.21-3.16; and MDD, HR = 1.68, 95 % CI = 1.44-1.95. The risks of developing MPDs varied across multiple types of critical illness related to ICU admission. CONCLUSIONS The risks of MPDs were significantly higher among the child and adolescent ICU survivors than among the controls. The development of appropriate MPD prevention strategies should be emphasized for this vulnerable population.
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Affiliation(s)
- Ping-Chung Wu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Ko MSM, Lee WK, Sultana R, Murphy B, Heng KYC, Loh SW, Poh PF, Lee JH. Psychological Outcomes in Families of PICU Survivors: A Meta-Analysis. Pediatrics 2024; 154:e2023064210. [PMID: 38916047 DOI: 10.1542/peds.2023-064210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Pediatric critical illness exposes family members to stressful experiences that may lead to subsequent psychological repercussions. OBJECTIVE To systematically review psychological outcomes among PICU survivors' family members. DATA SOURCES Four medical databases (PubMed, Embase, CINAHL and PsycInfo) were searched from inception till October 2023. STUDY SELECTION Studies reporting psychological disorders in family members of PICU patients with at least 3 months follow-up were included. Family members of nonsurvivors and palliative care patients were excluded. DATA EXTRACTION Screening and data extraction was performed according to PRISMA guidelines. Data were pooled using a random-effects model. RESULTS Of 5360 articles identified, 4 randomized controlled trials, 16 cohort studies, and 2 cross-sectional studies were included (total patients = 55 597; total family members = 97 506). Psychological distress was reported in 35.2% to 64.3% and 40.9% to 53% of family members 3 to 6 months and 1 year after their child's PICU admission, respectively. Post-traumatic stress disorder was diagnosed in 10% to 48% of parents 3 to 9 months later. Parents that experienced moderate to severe anxiety and depression 3 to 6 months later was 20.9% to 42% and 6.1% to 42.6%, respectively. Uptake of mental counseling among parents was disproportionately low at 0.7% to 29%. Risk factors for psychiatric morbidity include mothers, parents of younger children, and longer duration of PICU stay. LIMITATIONS The majority of studies were on parents with limited data on siblings and second degree relatives. CONCLUSIONS There is a high burden of psychological sequelae in family members of PICU survivors. Risk stratification to identify high-risk groups and early interventions are needed.
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Affiliation(s)
- Michelle Shi Min Ko
- Singapore Health Services, SingHealth, Singapore
- Duke-NUS Medical School, Singapore
| | - Wai Kit Lee
- Singapore Health Services, SingHealth, Singapore
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Australia
| | | | - Beverly Murphy
- Duke University, Medical Center Library and Archives, Durham, North Carolina
| | | | - Sin Wee Loh
- KK Women's and Children's Hospital, Children's ICU, Singapore
| | - Pei Fen Poh
- KK Women's and Children's Hospital, Children's ICU, Singapore
| | - Jan Hau Lee
- Duke-NUS Medical School, Singapore
- KK Women's and Children's Hospital, Children's ICU, Singapore
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3
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Carlton EF, Yagiela LM. Improving PICU Family Outcomes: Moving From Measurement Toward Interventions. Pediatrics 2024; 154:e2024066285. [PMID: 38916041 DOI: 10.1542/peds.2024-066285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 06/26/2024] Open
Affiliation(s)
- Erin F Carlton
- Division of Critical Care Medicine, Department of Pediatrics
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Lauren M Yagiela
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
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4
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Chau AN, Eckberg RA, Laksana E, Ehrlich L, Ledbetter DR, Aczon MD, Gold JI, Wetzel RC, Nelson LP. Prehospitalization Trauma and Physiologic Factors Associated with the Presence of Post-traumatic Stress 3 Months After PICU Discharge. J Intensive Care Med 2024; 39:268-276. [PMID: 38105524 DOI: 10.1177/08850666231201786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Children admitted to the pediatric intensive care unit (PICU) have post-traumatic stress (PTS) rates up to 64%, and up to 28% of them meet criteria for PTS disorder (PTSD). We aim to examine whether a prior trauma history and increased physiologic parameters due to a heightened sympathetic response are associated with later PTS. Our hypothesis was children with history of prehospitalization trauma, higher heart rates, blood pressures, cortisol, and extrinsic catecholamine administration during PICU admission are more likely to have PTS after discharge. METHODS This is a prospective, observational study of children admitted to the PICU at an urban, quaternary, academic children's hospital. Children aged 8 to 17 years old without developmental delay, severe psychiatric disorder, or traumatic brain injury were included. Children's prehospitalization trauma history was assessed with a semistructured interview. All in-hospital variables were from the electronic medical record. PTS was present if children had 4 of the Diagnostic and Statistical Manual of Mental Disorders IV criteria for PTSD. Student's t- and chi-squared tests were used to compare the presence or absence of prior trauma and all of the PICU-associated variables. RESULTS Of the 110 children at baseline, 67 had 3-month follow-up. In the latter group, 46% met the criteria for PTS, mean age of 13 years (SD 3), 57% male, a mean PRISM III score of 4.9 (SD 4.3), and intensive care unit length of stay 6.5 days (SD 7.8). There were no statistically significant differences in the demographics of the children with and without PTS. The only variable to show significance was trauma history; children with prehospitalization trauma were more likely to have PTS at 3-month follow-up (P = .02). CONCLUSIONS Prehospitalization trauma history was associated with the presence of PTS after admission to the PICU. This study suggests future studies should shift to the potential predictive benefit of screening children for trauma history upon PICU admission.
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Affiliation(s)
- Ariya N Chau
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ryan A Eckberg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Eugene Laksana
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Lili Ehrlich
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - David R Ledbetter
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Melissa D Aczon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jeffrey I Gold
- Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, University Center for Excellence in Developmental Disabilities, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Departments of Anesthesiology and Psychiatry & Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Randall C Wetzel
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lara P Nelson
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, University Center for Excellence in Developmental Disabilities, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Chlebowski MM, Stark C, Khoury PR, Zang H, Baenziger J, Kasparian NA. Evaluation of the use of visual storytelling as an educational intervention in the cardiac ICU: reaching parents before they are in crisis. Cardiol Young 2023:1-9. [PMID: 38131140 DOI: 10.1017/s1047951123004201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To evaluate the acceptability and safety of educational videos utilising visual storytelling to provide information about the cardiac ICU and post-operative care to parents. Videos were designed to educate, further encourage parents to engage in their child's cardiac care, and address common sources of distress. STUDY DESIGN Two educational videos and survey were sent to 29 families of children previously admitted to the cardiac ICU (April 2020-March 2021). Views regarding information quality, quantity, format, and relevance were assessed, as were parents' emotional responses. Quantitative thresholds for safety and acceptability were set a priori. An inductive approach to content analysis was applied to identify themes in qualitative data. RESULTS Sixteen parents participated (response rate: 55%). All acceptability and safety thresholds were met; 92% of parents rated the videos as helpful and 85% were "very" or "extremely likely" to recommend them to other families of children with CHD. No participants reported significant distress after viewing the videos. Expressions of parental engagement with their child's care team were common (92%). In qualitative responses, parents perceived the videos as potentially helpful in reducing distress if viewed prior to cardiac ICU admission. CONCLUSION Visual storytelling to orient parents to the cardiac ICU and address common stressors was found to be safe and acceptable when tested with parents of children previously admitted to the cardiac ICU. Further prospective studies are needed to test intervention effects when videos are viewed before or during cardiac ICU admission, especially for mitigating anxiety and traumatic stress associated with admission.
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Affiliation(s)
- Meghan M Chlebowski
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christiana Stark
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Philip R Khoury
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - Huaiyu Zang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Julia Baenziger
- Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Heart and Mind Wellbeing Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nadine A Kasparian
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Heart and Mind Wellbeing Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Colville GA. Mental Health Provision in PICU: An Analysis of Referrals to an Embedded Psychologist Over 20 Years at a Single Center. Pediatr Crit Care Med 2023; 24:e592-e601. [PMID: 37638788 DOI: 10.1097/pcc.0000000000003341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
OBJECTIVES The main aim of this study was to illustrate the type of mental health provision possible on PICU by describing the nature of referrals of child patients and their parents to an embedded psychologist over a 20-year period, adding to the literature on intervention and service development. DESIGN Retrospective evaluation of anonymized departmental database. SETTING Twelve-bed PICU at a teaching hospital in a major urban center. PATIENTS Five hundred forty-five consecutive referrals for support for parent and/or child by PICU staff between 1998 and 2017. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Referrals increased from seven of 288 (2.4%) in 1998 to 85 of 643 (13.2%) in 2017. The majority were for parent support initially (456/545, 84%). Mean ( sd ) number of contacts was 4.5 (10.2), range 1 to 143, and mode was 1. Patient gender and age typical of the total PICU population, but referrals were more common where children had an oncology or trauma diagnosis ( p < 0.001). Comparisons with other inpatient referrals at the same hospital revealed a higher proportion of requests were made for parent support on PICU (456/545 [84%] vs 789/1,997 [40%]; p < 0.001) and that nurses were more likely to initiate referrals on PICU than on the other wards (437/543 [80%] vs 1,190/1,993 [60%]; p < 0.001). In other respects, the two groups were similar in terms of number of sessions, waiting times, and attendance rates. CONCLUSIONS Growing appreciation of the psychological impact of a child's admission to PICU has been associated with increasing referral to an embedded psychologist over a 20-year period, at this center. Clinical and service implications are outlined in the context of the latest research on the mitigation of post-intensive care syndrome in this population.
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Affiliation(s)
- Gillian A Colville
- Paediatric Psychology Service, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
- New affiliation for Dr. Colville: Population Health Research Institute, St George's, University of London, London, United Kingdom
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7
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Hassinger AB, Afzal S, Rauth M, Breuer RK. Pediatric Intensive Care Unit related Sleep and Circadian Dysregulation: a focused review. Semin Pediatr Neurol 2023; 48:101077. [PMID: 38065630 DOI: 10.1016/j.spen.2023.101077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 12/18/2023]
Abstract
The pediatric intensive care unit (PICU) is bright, loud, and disruptive to children. Strategies to improve the sleep of adults in the ICU have improved delirium and mortality rates. Children need more sleep than adults for active growth, healing, and development when well; this is likely true when they are critically ill. This review was performed to describe what we know in this area to date with the intent to identify future directions for research in this field. Since the 1990s, 16 articles on 14 observational trials have been published investigating the sleep on a total of 312 critically ill children and the melatonin levels of an additional 144. Sleep measurements occurred in 9 studies through bedside observation (n = 2), actigraphy (n = 2), electroencephalogram (n = 1) and polysomnography (n = 4), of which polysomnography is the most reliable. Children in the PICU sleep more during the day, have fragmented sleep and disturbed sleep architecture. Melatonin levels may be elevated and peak later in critically ill children. Early data suggest there are at-risk subgroups for sleep and circadian disruption in the PICU including those with sepsis, burns, traumatic brain injury and after cardiothoracic surgery. The available literature describing the sleep of critically ill children is limited to small single-center observational studies with varying measurements of sleep and inconsistent findings. Future studies should use validated measurements and standardized definitions to begin to harmonize this area of medicine to build toward pragmatic interventional trials that may shift the paradigm of care in the pediatric intensive care unit.
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Affiliation(s)
- Amanda B Hassinger
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences; Division of Pulmonary and Sleep Medicine, John R. Oishei Children's Hospital of Buffalo, Buffalo, NY.
| | - Syeda Afzal
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences; Division of Pediatric Critical Care, John R. Oishei Children's Hospital of Buffalo, Buffalo, NY
| | - Maya Rauth
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences; John R. Oishei Children's Hospital of Buffalo, Buffalo, NY
| | - Ryan K Breuer
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences; Division of Pediatric Critical Care, John R. Oishei Children's Hospital of Buffalo, Buffalo, NY
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8
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Pryce P, Gangopadhyay M, Edwards JD. Parental Adverse Childhood Experiences and Post-PICU Stress in Children and Parents. Pediatr Crit Care Med 2023; 24:1022-1032. [PMID: 37615404 DOI: 10.1097/pcc.0000000000003339] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Hospitalization in a PICU is a stressful experience for children and their parents, with many experiencing posttraumatic stress disorder (PTSD) after discharge. Risk factors may include preillness traumatic events, such as adverse childhood experiences (ACEs). We sought to assess the feasibility of screening ACEs in parents of children admitted to a PICU, their prevalence, and their association with post-PICU PTSD symptoms in them and their children. DESIGN Single-center prospective observational study. SETTING Urban academic children's hospital from January to December 2021. PATIENTS One hundred forty-five children (2-18 yr old, admitted ≥ 2 d) and their parents. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data on parental demographics, ACEs, coping skills, and PICU environmental stressors, as well as patient clinical data, were collected. One month after PICU discharge, parents completed inventories assessing PTSD symptoms in them and their children. Bivariate and logistic regression analyses were used to explore associations of ACEs with post-PICU PTSD. Of 145 enrolled parents, 95% completed the ACE questionnaire, 58% of whom reported greater than or equal to 1 ACE, and 14% had substantial (≥ 4) ACEs. Parent and patient follow-up was 79% and 70%, respectively. Sixteen percent of parents had provisional PTSD. Regression analysis showed parents with greater than or equal to 4 ACEs had 10 times greater odds of parental PTSD, compared to parents with less than 4 ACEs, (adjusted odds ratio [aOR] = 10.2; 95% CI, 1.03-100.9; p = 0.047). Fifty-six percent of patients screened at risk for PTSD. There was no association between substantial parental ACEs and patients' risk for PTSD (aOR = 3.5 [95% CI, 0.56-21.31]; p = 0.18). CONCLUSIONS ACEs were common among parents of critically ill children. Having substantial parental ACEs was associated with provisional parental PTSD after their child's PICU admission, but not with PTSD in the children. Family-centered care that seeks to mitigate post-PICU stress should be mindful of the potential relevance of parental ACEs.
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Affiliation(s)
- Patrice Pryce
- Section of Critical Care, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Maalobeeka Gangopadhyay
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Jeffrey D Edwards
- Section of Critical Care, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Evans REC, Barber V, Ramnarayan P, Davies P, Wray J. Emergency Inter-Hospital Transfer of Children to PICUs in the United Kingdom: Qualitative Exploration of Parents' Experiences of Retrieval Teams. Pediatr Crit Care Med 2023; 24:e476-e486. [PMID: 37166250 DOI: 10.1097/pcc.0000000000003267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Each year in the United Kingdom there are around 5,000 inter-hospital transfers of critically ill children into PICUs. There are few published descriptions of what this experience is like for parents. The objective was to describe parents' experiences of the inter-hospital transfer of their critically ill child to a PICU. DESIGN Qualitative in-depth interviews. SETTING Twenty-four PICUs in England and Wales. PARTICIPANTS Parent interview participants ( n = 30) were purposively sampled from a larger pool of parent questionnaire respondents to create a sample diverse in child's age, presenting medical illness, retrieval team and whether a parent traveled in the ambulance. MEASUREMENT AND MAIN RESULTS Open-ended semi-structured interviews using topic guides to encourage parents to describe their experiences of transfer. Interviews were audio recorded, transcribed verbatim and thematically analyzed using Framework Analysis. Parents' perceptions of transport staff as confident and competent through observation of clinical care, and positive communication experiences during the transfer process, were related to feelings of trust and being supported, as well as relief from distress. Parents varied in their needs for conversation and support. Parents who did not travel in the ambulance had fewer opportunities to interact with the transport team and experienced different challenges in the period prior to their child's admission to the PICU. CONCLUSIONS Retrieval teams can influence how parents experience their child's emergency transfer to the PICU, offering parents proximity to knowledgeable staff. Satisfaction may be related to matching parents' needs. Understanding parents' needs and optimizing opportunities for effective communication between parents and staff are beneficial to parents.
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Affiliation(s)
- Ruth E C Evans
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Vicky Barber
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Anaesthetics, Pain Medicine and Intensive Care (APMIC) Section, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Patrick Davies
- Paediatric Intensive Care, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Reddy AR, Stinson HR, Alcamo AM, Pinto NP, Fitzgerald JC. Pediatric Sepsis Requiring Intensive Care Admission: Potential Structured Follow-Up Protocols to Identify and Manage New or Exacerbated Medical Conditions. Risk Manag Healthc Policy 2023; 16:1881-1891. [PMID: 37736598 PMCID: PMC10511018 DOI: 10.2147/rmhp.s394458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
Pediatric sepsis is a leading cause of morbidity and mortality in children globally. Children who require the pediatric intensive care unit (PICU) are at high risk for new or worsening co-morbidities, as well as readmission. This review describes the current state of protocolized follow-up after pediatric sepsis requiring PICU admission. We searched Medline and EMBASE databases for studies published in English from 2005 to date. Duplicates, review articles, abstracts and poster presentations were excluded; neonatal intensive care unit (NICU) patients were also excluded since neonatal sepsis is variably defined and differs from the pediatric consensus definition. The search yielded 418 studies of which 55 were duplicates; the subsequent 363 studies were screened for inclusion criteria, yielding 31 studies for which full article screening was completed. Subsequently, 23 studies were excluded due to wrong population (9), wrong publication type (10), duplicate data (3) or wrong outcome (1). In total, nine studies were included for which we described study design, setting, population, sample size, outcomes, PICU core outcome domain, and results. There were 4 retrospective cohort studies, 4 prospective cohort studies, 1 retrospective case series and no prospective trials. These studies show the varying trajectories of recovery after discharge, with the common finding that new or worsening morbidities are worse within months of discharge, but may persist. Sepsis survivors may have distinct needs and a different post-PICU trajectory compared to other critically ill children, particularly in quality of life and neurocognitive outcomes. Future research should focus on developing screening protocols and studying protocolized follow-up trials to reduce morbidity after pediatric sepsis.
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Affiliation(s)
- Anireddy R Reddy
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hannah R Stinson
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alicia M Alcamo
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Neethi P Pinto
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Julie C Fitzgerald
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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11
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Colagiovanni Morrison A, Hall TA, Kumar V, Williams CN. The Impact of Sleep Disturbances on Health-Related Quality of Life in Children With Acquired Brain Injury After Critical Care. Pediatr Neurol 2023; 141:25-33. [PMID: 36739796 PMCID: PMC10040440 DOI: 10.1016/j.pediatrneurol.2023.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 12/07/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Over 60,000 children with acquired brain injury (ABI) in the United States require admission to pediatric intensive care units annually. Over 50% suffer sleep-wake disturbances (SWDs) months after discharge. Given the importance of sleep to brain repair, we hypothesized that SWD would be associated with poorer health-related quality of life (HRQOL). METHODS Cross-sectional analysis of prospectively collected data in children with ABI aged 3 to 18 years evaluated 1 to 3 months after critical care hospitalization (N = 151). SWD measured by Sleep Disturbances Scale for Children and defined as T-score ≥60 signifying moderate-severe risk of sleep disorders. HRQOL measured by Pediatric Quality of Life Inventory, which defines minimal clinically important difference as 4.5 points in total score. Secondary outcomes included scores for Physical, Emotional, Social, and School Function domains. SWD groups were compared with Mann-Whitney tests. Multiple linear regression evaluated association between SWD and HRQOL controlling for patient and ABI characteristics. Significance was defined as P < 0.05. RESULTS SWDs were present in 66% (n = 100). HRQOL total score was significantly lower in children with SWD (median = 70; interquartile range [IQR] = 54, 80) versus without (median = 85; IQR = 67, 94; P < 0.001). Median scores in emotional, social, and school domains were significantly lower in SWD group (all P < 0.01). When controlling for age, sex, critical care interventions, preadmission comorbidities, and decline from preadmission Functional Status Scale, presence of SWD significantly reduced HRQOL total score nearly three times minimal clinically important difference (β-coefficient = -12.1; 95% confidence Interval = -17.9, -6.2). CONCLUSIONS SWD following ABI significantly decreased HRQOL overall and across multiple health domains. Sleep is potentially modifiable. Our data support future studies targeting sleep to improve outcomes after ABI.
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Affiliation(s)
- Amy Colagiovanni Morrison
- Oregon Health & Science University, Pediatric Critical Care and Neurotrauma Recovery Program, Portland, Oregon.
| | - Trevor A Hall
- Oregon Health & Science University, Pediatric Critical Care and Neurotrauma Recovery Program, Portland, Oregon; Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Vivek Kumar
- Oregon Health & Science University, Pediatric Critical Care and Neurotrauma Recovery Program, Portland, Oregon
| | - Cydni N Williams
- Oregon Health & Science University, Pediatric Critical Care and Neurotrauma Recovery Program, Portland, Oregon; Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
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12
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de Pellegars A, Cariou C, Le Floch M, Duverger P, Boussicault G, Riquin E. Risk factors of post-traumatic stress disorder after hospitalization in a pediatric intensive care unit: a systematic literature review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02141-8. [PMID: 36739584 DOI: 10.1007/s00787-023-02141-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/05/2023] [Indexed: 02/06/2023]
Abstract
The number of studies on post-traumatic stress disorder after hospitalization in a pediatric intensive care unit raised since 2004. The objective of this systematic review was to summarize and critically examine the literature about risk factors for these children to develop post-traumatic stress disorder following admission to an intensive care unit. The data sources were PubMed, Cochrane, Web of Science, PsycInfo, SUDOC, Scopus, and ScienceDirect. Studies were selected if they were in English or French and published between 01/01/2004 and 31/01/2022. Studies were excluded if patients were less than 1 month old and if no post-traumatic stress disorder was found. The internal validity and risk of bias were assessed using the National Institutes of Health Study Quality Assessment Tools for observational studies and the Ottawa Scale was used for the interventional study. The search yielded 523 results and 22 articles met inclusion criteria. Three common risk factors were identified from the data: parental post-traumatic stress disorder (especially in mothers), severity of illness and delusional memories. Internalizing behavior in children, acute parent and child stress, emergency admission and sepsis are also potential risk factors that require further investigation. The prevalence of this pathology is substantial (between 14 and 36%) and increasing awareness among pediatricians and psychologists seems necessary. Prevention programs are being studied to reduce the incidence of post-traumatic stress disorder in this population. Child and adolescent psychiatry liaison should collaborate with pediatric teams to support this objective.
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Affiliation(s)
- Alice de Pellegars
- Department of Pediatric Intensive Care, University Hospital of Angers, Angers, France.
| | - Cindy Cariou
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
| | - Marine Le Floch
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
| | - Philippe Duverger
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
- Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France
- Laboratory of Psychology, LPPL EA4638, University of Angers, Angers, France
| | - Gérald Boussicault
- Department of Pediatric Intensive Care, University Hospital of Angers, Angers, France
| | - Elise Riquin
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
- Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France
- Laboratory of Psychology, LPPL EA4638, University of Angers, Angers, France
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13
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Long DA, Waak M, Doherty NN, Dow BL. Brain-Directed Care: Why Neuroscience Principles Direct PICU Management beyond the ABCs. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121938. [PMID: 36553381 PMCID: PMC9776953 DOI: 10.3390/children9121938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Major advances in pediatric intensive care (PICU) have led to increased child survival. However, the long-term outcomes among these children following PICU discharge are a concern. Most children admitted to PICU are under five years of age, and the stressors of critical illness and necessary interventions can affect their ability to meet crucial developmental milestones. Understanding the neuroscience of brain development and vulnerability can inform PICU clinicians of new ways to enhance and support the care of these most vulnerable children and families. This review paper first explores the evidence-based neuroscience principles of brain development and vulnerability and the impact of illness and care on children's brains and ultimately wellbeing. Implications for clinical practice and training are further discussed to help optimize brain health in children who are experiencing and surviving a critical illness or injury.
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Affiliation(s)
- Debbie A. Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
- Correspondence: ; Tel.: +61-7-3138-3834
| | - Michaela Waak
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
| | - Nicola N. Doherty
- Regional Trauma Network, SPPG, DOH, Belfast BT2 8BS, Northern Ireland, UK
- School of Psychology, Faculty of Life and Health Sciences, Coleraine Campus, Ulster University, Coleraine BT52 1SA, Northern Ireland, UK
| | - Belinda L. Dow
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
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14
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Demers LA, Wright NM, Kopstick AJ, Niehaus CE, Hall TA, Williams CN, Riley AR. Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101575. [PMID: 36291511 PMCID: PMC9600460 DOI: 10.3390/children9101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022]
Abstract
Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.
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Affiliation(s)
- Lauren A. Demers
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Naomi M. Wright
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Psychology, University of Denver, Denver, CO 80208, USA
| | - Avi J. Kopstick
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Texas Tech University Health Science Center El Paso, El Paso, TX 97705, USA
| | - Claire E. Niehaus
- Division of Psychology and Psychiatry, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Correspondence: ; Tel.: +1-503-418-2134
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Andrew R. Riley
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
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15
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O'Toole S, Suarez C, Adair P, McAleese A, Willis S, McCormack D. A Systematic Review of the Factors Associated with Post-Traumatic Growth in Parents Following Admission of Their Child to the Intensive Care Unit. J Clin Psychol Med Settings 2022; 29:509-537. [PMID: 35526209 PMCID: PMC9399044 DOI: 10.1007/s10880-022-09880-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 12/01/2022]
Abstract
This systematic review aims to identify the demographic, clinical and psychological factors associated with post-traumatic growth (PTG) in parents following their child's admission to the intensive care unit (ICU). Papers published up to September 2021 were identified following a search of electronic databases (PubMed, Medline, Web of Science, PsycINFO, CINAHL, PTSDpubs and EMBASE). Studies were included if they involved a sample of parents whose children were previously admitted to ICU and reported correlational data. 1777 papers were reviewed. Fourteen studies were eligible for inclusion; four were deemed to be of good methodological quality, two were poor, and the remaining eight studies were fair. Factors associated with PTG were identified. Mothers, and parents of older children, experienced greater PTG. Parents who perceived their child's illness as more severe had greater PTG. Strong associations were uncovered between PTG and post-traumatic stress, psychological well-being and coping. PTG is commonly experienced by this population. Psychological factors are more commonly associated with PTG in comparison with demographic and clinical factors, suggesting that parents' subjective ICU experience may be greater associated with PTG than the objective reality.
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Affiliation(s)
- S O'Toole
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, UK.
| | - C Suarez
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, UK
| | - P Adair
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, UK
| | - A McAleese
- Clinical Psychology Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - S Willis
- Clinical Psychology Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - D McCormack
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, UK
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16
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Long D, Gibbons K, Dow B, Best J, Webb KL, Liley HG, Stocker C, Thoms D, Schlapbach LJ, Wharton C, Lister P, Matuschka L, Castillo MI, Tyack Z, Bora S. Effectiveness-implementation hybrid-2 randomised trial of a collaborative Shared Care Model for Detecting Neurodevelopmental Impairments after Critical Illness in Young Children (DAISY): pilot study protocol. BMJ Open 2022; 12:e060714. [PMID: 35840297 PMCID: PMC9295674 DOI: 10.1136/bmjopen-2021-060714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION In Australia, while paediatric intensive care unit (PICU) mortality has dropped to 2.2%, one in three survivors experience long-term neurodevelopmental impairment, limiting their life-course opportunities. Unlike other high-risk paediatric populations, standardised routine neurodevelopmental follow-up of PICU survivors is rare, and there is limited knowledge regarding the best methods. The present study intends to pilot a combined multidisciplinary, online screening platform and general practitioner (GP) shared care neurodevelopmental follow-up model to determine feasibility of a larger, future study. We will also assess the difference between neurodevelopmental vulnerability and parental stress in two intervention groups and the impact of child, parent, sociodemographic and illness/treatment risk factors on child and parent outcomes. METHODS AND ANALYSIS Single-centre randomised effectiveness-implementation (hybrid-2 design) pilot trial for parents of children aged ≥2 months and <4 years discharged from PICU after critical illness or injury. One intervention group will receive 6 months of collaborative shared care follow-up with GPs (supported by online outcome monitoring), and the other will be offered self-directed screening and education about post-intensive care syndrome and child development. Participants will be followed up at 1, 3 and 6 months post-PICU discharge. The primary outcome is feasibility. Secondary outcomes include neurodevelopmental vulnerability and parental stress. An implementation evaluation will analyse barriers to and facilitators of the intervention. ETHICS AND DISSEMINATION The study is expected to lead to a full trial, which will provide much-needed guidance about the clinical effectiveness and implementation of follow-up models of care for children after critical illness or injury. The Children's Health Queensland Human Research Ethics Committee approved this study. Dissemination of the outcomes of the study is expected via publication in a peer-reviewed journal, presentation at relevant conferences, and via social media, podcast presentations and open-access medical education resources. REGISTRATION DETAILS The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry as 'Pilot testing of a collaborative Shared Care Model for Detecting Neurodevelopmental Impairments after Critical Illness in Young Children' (the DAISY Pilot Study). TRIAL REGISTRATION NUMBER ACTRN12621000799853.
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Affiliation(s)
- Debbie Long
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Kristen Gibbons
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Belinda Dow
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - James Best
- General Practice, Junction Street Family Practice, Nowra, New South Wales, Australia
| | - Kerri-Lyn Webb
- Developmental Paediatrics, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Helen G Liley
- Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
- Newborn Medicine, Mater Mother's Hospital, South Brisbane, Queensland, Australia
| | - Christian Stocker
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Debra Thoms
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Luregn J Schlapbach
- Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Carolyn Wharton
- Consumer Representative, Health Consumers Queensland, Brisbane, Queensland, Australia
| | - Paula Lister
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Critical Care Unit, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Lori Matuschka
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Maria Isabel Castillo
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zephanie Tyack
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Samudragupta Bora
- Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
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Hall TA, Greene RK, Lee JB, Leonard S, Bradbury KR, Drury K, Recht G, Randall J, Norr ME, Williams CN. Post-Intensive Care Syndrome in a Cohort of School-Aged Children and Adolescent ICU Survivors: The Importance of Follow-up in the Acute Recovery Phase. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1747935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractPediatric intensive care unit (PICU) survivors experience a collection of physical, cognitive, emotional, and social symptoms named post-intensive care syndrome (PICS). We aimed to quantify PICS morbidities from multiple stakeholder perspectives across domains. Using physician, neuropsychologist, and parent/caregiver-completed outcome measures across domains in a cross-sectional analysis of 186 children between the ages of 8 and 19 years with data from a PICU follow-up clinic 1 to 3 months after PICU discharge, we quantified PICS morbidities and used Spearman correlation to evaluate interdependence of PICS domains. Compared with pre-hospitalization functioning, new PICS-related morbidities were observed and significant correlations were identified between the PICS domains. Results highlight the need to identify and support patients and families for multiple morbidities simultaneously across all relevant PICS domains; moreover, an important divergence between caregiver report, physician, and neuropsychologist assessment was also found, showcasing the importance of multiple assessments and perspectives. New PICS morbidities across domains are common after discharge from the PICU, and timely follow-up care is needed that involves collaboration/integration of physicians, neuropsychologists, youth, and families to effectively identify and treat PICS-related issues.
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Affiliation(s)
- Trevor A. Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
| | - Rachel K. Greene
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Justin B. Lee
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Skyler Leonard
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Kathryn R. Bradbury
- Children's Neuropsychological Services, Andover, Massachusetts, United States
| | - Kurt Drury
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
- Division of Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Grace Recht
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
| | - Julie Randall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
| | - Megan E. Norr
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
- Division of Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
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Erçin-Swearinger H, Lindhorst T, Curtis JR, Starks H, Doorenbos AZ. Acute and Posttraumatic Stress in Family Members of Children With a Prolonged Stay in a PICU: Secondary Analysis of a Randomized Trial. Pediatr Crit Care Med 2022; 23:306-314. [PMID: 35190503 PMCID: PMC9071176 DOI: 10.1097/pcc.0000000000002913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify the prevalence of screening criteria for acute and posttraumatic stress disorders (PTSDs) and stress symptoms among family members of children in the PICU for more than 8 days and examine risk factors for stress symptoms. DESIGN Secondary analysis of data from a randomized trial of a palliative care intervention conducted between 2010 and 2014. SETTING An urban pediatric hospital in Seattle, WA. SUBJECTS The sample included 377 family members of 220 children. INTERVENTIONS Family Communication Study. MEASUREMENTS AND MAIN RESULTS Outcomes were symptom scores and diagnostic screening criteria for acute stress disorder (ASD) and PTSD. Predictors included demographic- and admission-related characteristics and hypothesized risk factors for developing stress-related mental health disorders. The mean score for acute stress symptoms during the ICU stay was 40.3 (sd = 13.8) and 59 family members in total met diagnostic screening criteria for ASD during hospitalization (15.6%). At 3-month follow-up, the mean score for posttraumatic stress symptoms was 30.8 (sd = 12.9) and 52 family members met diagnostic criteria for PTSD (13.8%). Factors associated with meeting ASD screening criteria were unplanned admission and poorer family relationships. Factors associated with PTSD symptoms and diagnosis were longer length of stay, meeting ASD criteria during admission, child's death, and less perceived social support. CONCLUSIONS Meeting screening criteria for PTSD was associated with demographic, length of stay, and family relationships among family members of seriously ill children. PTSD outcomes were higher among family members whose child died. This study helps identify risk factors that can be used to target needed psychosocial screening, monitoring and support during and following a prolonged PICU admission, as well as family-centered interventions and supportive bereavement intervention for the family members of a deceased child.
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Affiliation(s)
| | - Taryn Lindhorst
- School of Social Work, University of Washington, Seattle, WA
| | | | - Helene Starks
- Department of Bioethics and Humanities, University of Washington, Seattle, WA
| | - Ardith Z Doorenbos
- Department of Behavioral Nursing Science, University of Illinois, Chicago, IL
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Woolgar FA, Wilcoxon L, Pathan N, Daubney E, White D, Meiser-Stedman R, Colville GA. Screening for Factors Influencing Parental Psychological Vulnerability During a Child's PICU Admission. Pediatr Crit Care Med 2022; 23:286-295. [PMID: 35081084 DOI: 10.1097/pcc.0000000000002905] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify the risks of developing post-traumatic stress disorder (PTSD) and/or depression in parents following their child's PICU admission using a brief screening instrument and to examine the associations with these risks. DESIGN A cross-sectional parental survey. SETTING A general 13-bed PICU at a large teaching hospital. SUBJECTS One hundred and seven parents of 75 children admitted to the PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All parents completed the 10-item Posttraumatic Adjustment Screen (PAS) before discharge. The PAS assesses risk factors known to be associated with poorer psychological outcome, including psychosocial variables pretrauma and peritrauma, and acute stress. Parents' scores on the PAS indicated that 64 (60%) were at risk of developing PTSD and 80 (75%) were at risk of developing depression following their child's admission. Univariate analyses suggested that psychosocial variables, such as preexisting stressors and a history of previous mental health problems, were more strongly associated with PAS risk scores for PTSD and depression than medical or sociodemographic factors. In logistic regression analyses, a history of previous mental health problems was significantly associated with risk of developing PTSD and depression (p < 0.001) explaining 28% and 43% of the variance in these outcomes. CONCLUSIONS This study suggests that a significant number of parents on PICU are potentially at risk of developing PTSD and/or depression postdischarge and that psychosocial factors, pretrauma and peritrauma, are stronger determinants of this risk, and of acute distress, than other variables. Identification of vulnerable parents during admission, using a measure such as the PAS, could facilitate the targeting of support and monitoring, acutely and postdischarge, at those who might be most likely to benefit.
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Affiliation(s)
- Francesca A Woolgar
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Lucy Wilcoxon
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Nazima Pathan
- Department of Paediatrics, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Esther Daubney
- Department of Paediatrics, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Deborah White
- Department of Paediatrics, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Richard Meiser-Stedman
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Gillian A Colville
- Paediatric Psychology Service, St George's Hospital, London, United Kingdom
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Hordijk JA, Verbruggen SC, Buysse CM, Utens EM, Joosten KF, Dulfer K. Neurocognitive functioning and health-related quality of life of children after pediatric intensive care admission: a systematic review. Qual Life Res 2022; 31:2601-2614. [PMID: 35357629 PMCID: PMC9356943 DOI: 10.1007/s11136-022-03124-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study systematically reviewed recent findings on neurocognitive functioning and health-related quality of life (HRQoL) of children after pediatric intensive care unit admission (PICU). DATA SOURCES Electronic databases searched included Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. The search was limited to studies published in the last five years (2015-2019). STUDY SELECTION Original studies assessing neurocognitive functioning or HRQoL in children who were previously admitted to the PICU were included in this systematic review. DATA EXTRACTION Of the 3649 identified studies, 299 met the inclusion criteria based on title abstract screening. After full-text screening, 75 articles were included in the qualitative data reviewing: 38 on neurocognitive functioning, 33 on HRQoL, and 4 on both outcomes. DATA SYNTHESIS Studies examining neurocognitive functioning found overall worse scores for general intellectual functioning, attention, processing speed, memory, and executive functioning. Studies investigating HRQoL found overall worse scores for both physical and psychosocial HRQoL. On the short term (≤ 12 months), most studies reported HRQoL impairments, whereas in some long-term studies HRQoL normalized. The effectiveness of the few intervention studies during and after PICU admission on long-term outcomes varied. CONCLUSIONS PICU survivors have lower scores for neurocognitive functioning and HRQoL than children from the general population. A structured follow-up program after a PICU admission is needed to identify those children and parents who are at risk. However, more research is needed into testing interventions in randomized controlled trials aiming on preventing or improving impairments in critically ill children during and after PICU admission.
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Affiliation(s)
- José A Hordijk
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Sascha C Verbruggen
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Corinne M Buysse
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Elisabeth M Utens
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands.,Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Rijksstraatweg 145, 1115 AP, Amsterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 8, 3015 CN, Rotterdam, The Netherlands
| | - Koen F Joosten
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Karolijn Dulfer
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands.
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21
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Ko MSM, Poh PF, Heng KYC, Sultana R, Murphy B, Ng RWL, Lee JH. Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:e215767. [PMID: 35040918 PMCID: PMC8767488 DOI: 10.1001/jamapediatrics.2021.5767] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE The pediatric intensive care unit (PICU) exposes children to stressful experiences with potential long-term psychological repercussions. However, current understanding of post-PICU psychological outcomes is incomplete. OBJECTIVE To systematically review and evaluate reported long-term psychological outcomes among children previously admitted to the PICU. DATA SOURCES A systematic search of the Cumulative Index to Nursing and Allied Health Literature, Embase, MEDLINE (PubMed), and PsycINFO was conducted from database inception to June 2021. Search terms included phrases related to intensive care (eg, intensive care units and critical care) and terms for psychological disorders (eg, posttraumatic stress disorder, depressive disorder, conduct disorder, and neurodevelopmental disorder) limited to the pediatric population. STUDY SELECTION This systematic review and meta-analysis included randomized clinical trials and observational studies reporting psychological disorders among children younger than 18 years who were admitted to the PICU with follow-up for at least 3 months. Psychological disorders were defined using the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Children were excluded if they were admitted to the PICU for primary brain conditions (eg, traumatic brain injury, meningoencephalitis, and brain tumors) or discharged to the home for palliative care. DATA EXTRACTION AND SYNTHESIS Titles and abstracts were independently screened by 2 reviewers, with data extraction conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were pooled using a random-effects model during meta-analysis. MAIN OUTCOMES AND MEASURES Age-corrected IQ scores and long-term psychological outcomes measured by scales such as the Child Behavior Checklist (higher scores indicate more behavioral problems) among children admitted to the PICU. RESULTS Of 9193 records identified, 31 independent studies (5 randomized clinical trials and 26 observational studies) involving 7786 children (mean age, 7.3 years [95% CI, 6.2-8.4 years]; 4267 boys [54.8%]; race and ethnicity were not reported by all studies) admitted to the PICU were included. Overall, 1 of 19 children (5.3%) to 14 of 16 children (88.0%) previously admitted to the PICU were reported to have at least 1 psychological disorder. Studies that examined posttraumatic stress disorder reported that 6 of 60 children (10.0%) to 31 of 102 children (30.4%) met the diagnostic criteria for the disorder at 3 to 6 months of follow-up. Compared with healthy children, those admitted to the PICU had lower IQ scores at 1 to 2 years of follow-up (mean, 89.40 points [95% CI, 88.33-90.47 points] vs 100.70 points [95% CI, 99.43-101.97 points]; P < .001) and 3 to 5 years of follow-up (mean, 88.54 points [95% CI, 83.92-93.16 points] vs 103.18 [95% CI, 100.36-105.99 points]; P < .001) and greater total emotional and behavioral problems at 4 years of follow-up (mean, 51.69 points [95% CI, 50.37-53.01 points] vs 46.66 points [95% CI, 45.20-48.13 points]; P < .001). CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found a high burden of psychological sequelae among children previously admitted to the PICU, suggesting that risk stratification and early interventions are needed for high-risk groups.
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Affiliation(s)
| | - Pei-Fen Poh
- Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore
| | | | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Beverly Murphy
- Medical Center Library and Archives, Duke University, Durham, North Carolina
| | - Regina Wan Leng Ng
- Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore
| | - Jan Hau Lee
- MD Programme, Duke-NUS Medical School, Singapore,Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore
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22
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Mental health outcomes in pediatric trauma patients: A 10 year real world analysis using a large database approach. J Pediatr Surg 2022; 57:291-296. [PMID: 34772514 DOI: 10.1016/j.jpedsurg.2021.09.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Traumatic injury is the leading cause of morbidity and mortality among children in the United States. Single institution studies suggest an increased risk of poor mental health outcomes among these patients, but there are few population-based studies assessing this risk. METHODS The IBMⓇ MarketScanⓇ private insurance claims database was used to identify children (6-17yo) with traumatic injuries between 2007 and 2016. Time-to-event analysis was performed to compare rates of PTSD, depression, anxiety, and adjustment disorder among children admitted to the hospital compared to children treated in the emergency department (ED), urgent care (UC), or in the outpatient setting, and to children admitted with uncomplicated appendicitis. RESULTS Among children admitted for traumatic injury, 3.3% developed a subsequent mental health diagnosis, and 1.6% developed PTSD. Children admitted for traumatic injury were at increased risk of developing a mental health condition (HR 1.34, p < 0.001) compared to those admitted for appendicitis. Children treated in the ED or UC for traumatic injury and those treated in the outpatient setting were also at increased risk (HR 1.20 and 1.18, p = 0.006 and p = 0.012, respectively). Among those admitted to the hospital, the risk of subsequent mental health diagnosis increased by 1.5% per day; in the first 31 days of hospitalization, the risk of PTSD diagnosis increased by 13% per day. CONCLUSION Children who sustain a traumatic injury are at increased risk of developing a mental health condition. PTSD rates found in our real world analysis are lower than those found in prospective studies, raising the possibility of under-recognition of PTSD in this population. LEVEL OF EVIDENCE Level II.
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23
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Long DA, Fink EL. Transitions from short to long-term outcomes in pediatric critical care: considerations for clinical practice. Transl Pediatr 2021; 10:2858-2874. [PMID: 34765507 PMCID: PMC8578758 DOI: 10.21037/tp-21-61] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022] Open
Abstract
Most children are surviving critical illness in highly resourced pediatric intensive care units (PICUs). However, in research studies, many of these children survive with multi-domain health sequelae that has the potential to affect development over many years, termed post-intensive care syndrome-pediatrics (PICS-p). Clinically, there are no recommendations for the assessment and follow-up of children with critical illness as exists for the premature neonatal and congenital heart disease populations. In research studies, primary and secondary outcomes are largely assessed at or prior to hospital discharge, disregarding post-hospital outcomes important to PICU stakeholders. Incorporating longer term outcomes into clinical and research programs, however, can no longer be overlooked. Barriers to outcomes assessments are varied and generalized vs. individualized, but some PICU centers are discovering how to overcome them and are providing this service to families-sometimes specific populations-in need. Research programs and funders are increasingly recognizing the value and need to assess long-term outcomes post-PICU. Finally, we should seek the strong backing of the PICU community and families to insist that long-term outcomes become our new clinical standard of care. PICUs should consider development of a multicenter, multinational collaborative to assess clinical outcomes and optimize care delivery and patient and family outcomes. The aim of this review is to present the potential considerations of implementing long-term clinical follow-up following pediatric critical illness.
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Affiliation(s)
- Debbie A Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Pediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Ericka L Fink
- Division of Pediatric Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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24
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Pediatric Critical Care Nurses' Practices Related to Sedation and Analgesia. Dimens Crit Care Nurs 2021; 40:280-287. [PMID: 34398564 DOI: 10.1097/dcc.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Pediatric intensive care unit (PICU) nurses may consider additional factors beyond validated tools when managing pain and sedation of children. However, these other factors and related beliefs, practices, and decision-making for analgesia and sedation have not been well described. OBJECTIVES This study describes nurses' beliefs, practices, and decision-making related to sedation and analgesia for mechanically ventilated children on a PICU and a pediatric cardiovascular ICU at a tertiary academic children's medical center in the United States. METHODS A 35-item web-based survey tool was developed to more fully identify nurses' pain, sedation, comfort, and analgesia beliefs, decisions, planning, and procedures for children who were mechanically ventilated in the ICU. It was distributed to 102 nurses in the PICU, pediatric cardiovascular ICU, and pediatric critical care float pool. RESULTS Twenty-six nurses (25%) responded; a majority worked the night shift and had 5 years or less of ICU experience. While participants believed intubated pediatric patients required moderate to deep sedation, approximately only half reported patients were adequately sedated. They reported that they were more likely to manage pain and sedation using specific behaviors and changes in vital signs than scores on a standardized scale. Nurses also reported routinely incorporating nonpharmacologic comfort measures. Premedication was more common for invasive procedures than for routine nursing care. DISCUSSION Pediatric ICU nurses in this study considered factors beyond standardized scales when evaluating and managing pain and sedation of ventilated children. Nurses prioritized children's specific behaviors, vital signs, and their own nursing judgment above standardized scales. Research is needed to describe nurses' practices beyond this small study and to define and validate additional assessment parameters to incorporate into decision-making to improve management and care outcomes.
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25
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Psychological Outcomes in Fathers of Critically Ill Children in the Pediatric Intensive Care Unit: A Systematic Review. J Clin Psychol Med Settings 2021; 29:249-261. [PMID: 34272639 DOI: 10.1007/s10880-021-09800-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Systematically review evidence of psychological distress in fathers of children admitted to the pediatric intensive care unit (PICU). Two reviewers independently reviewed 24 published articles that studied fathers during and closely following a PICU admission. Results are presented for psychological outcomes of stress, PTSD, anxiety and depression, family functioning, and other forms of distress. Potential moderators of distress are also presented. Although methodological variance and inconsistent findings make it difficult to draw definitive conclusions, mothers and fathers appear to experience similar levels of distress and psychiatric symptoms during and after a PICU admission. Fathers' distress may be characterized by feelings of helplessness and often manifests after discharge, later than for mothers. More research is needed to understand gender differences in the expression of parental distress during and after a PICU admission as this will serve to inform interventions designed to improve family functioning.
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26
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Parents' experiences during and after their child's stay in the paediatric intensive care unit - A qualitative interview study. Intensive Crit Care Nurs 2021; 67:103089. [PMID: 34238647 DOI: 10.1016/j.iccn.2021.103089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Having a child admitted to the paediatric intensive care unit (PICU) is often an emotional and stressful experience for parents. AIM The aim of the study was to explore parents' experiences during and after their child's hospitalization in the PICU and to investigate whether parents have a need for post-PICU follow-up. MATERIAL AND METHODS The research design was a qualitative study inspired by Ricoeur's phenomenological-hermeneutic approach. The context of the study was a six-bed PICU in a university hospital in Denmark. In 2017, semi-structured interviews were conducted with four couples and three mothers six to 14 weeks after their child had been discharged from the PICU. The data were analysed and interpreted through Ricoeur's three analytical levels and presented in themes and subthemes. FINDINGS Three themes were identified in the analytical process: "The challenging PICU stay", "The value of a network" and "The uncertain post-PICU trajectory". CONCLUSION Information, dialogue and interaction with familiar health professionals, the diary written by PICU nurses, the parents' personal network and social media supported the parents during and after the PICU stay. The parents expressed that post-PICU follow-up was not the most essential but that follow-up initiatives may be arranged individually.
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27
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Long-Term Outcomes and the Post-Intensive Care Syndrome in Critically Ill Children: A North American Perspective. CHILDREN-BASEL 2021; 8:children8040254. [PMID: 33805106 PMCID: PMC8064072 DOI: 10.3390/children8040254] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 12/14/2022]
Abstract
Advances in medical and surgical care for children in the pediatric intensive care unit (PICU) have led to vast reductions in mortality, but survivors often leave with newly acquired or worsened morbidity. Emerging evidence reveals that survivors of pediatric critical illness may experience a constellation of physical, emotional, cognitive, and social impairments, collectively known as the “post-intensive care syndrome in pediatrics” (PICs-P). The spectrum of PICs-P manifestations within each domain are heterogeneous. This is attributed to the wide age and developmental diversity of children admitted to PICUs and the high prevalence of chronic complex conditions. PICs-P recovery follows variable trajectories based on numerous patient, family, and environmental factors. Those who improve tend to do so within less than a year of discharge. A small proportion, however, may actually worsen over time. There are many gaps in our current understanding of PICs-P. A unified approach to screening, preventing, and treating PICs-P-related morbidity has been hindered by disparate research methodology. Initiatives are underway to harmonize clinical and research priorities, validate new and existing epidemiologic and patient-specific tools for the prediction or monitoring of outcomes, and define research priorities for investigators interested in long-term outcomes.
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28
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Rennick JE, Knox AM, Treherne SC, Dryden-Palmer K, Stremler R, Chambers CT, McRae L, Ho M, Stack DM, Dougherty G, Fudge H, Campbell-Yeo M. Family Members' Perceptions of Their Psychological Responses One Year Following Pediatric Intensive Care Unit (PICU) Hospitalization: Qualitative Findings From the Caring Intensively Study. Front Pediatr 2021; 9:724155. [PMID: 34557460 PMCID: PMC8452961 DOI: 10.3389/fped.2021.724155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: PICU hospitalization can have a profound impact on child survivors and their families. There is limited research on children's long-term recovery within the context of the family following critical illness. This study aimed to explore children's and parents' perceptions of long-term psychological and behavioral responses within the context of the family one year following PICU hospitalization. Materials and Methods: Caring Intensively is a mixed methods multi-site prospective cohort study that aims to examine children's psychological and behavioral responses over a 3-year period following PICU hospitalization. In this study, part of the qualitative arm of Caring Intensively, an interpretive descriptive design was used to explore children's recovery one year post-discharge. Purposive sampling was used to select 17 families, including 16 mothers, 6 fathers, and 9 children. Semi-structured, audio-recorded interviews were conducted. Data were analyzed iteratively using the constant comparison method. Results: Families described efforts to readapt to routine life and find a new normal following PICU hospitalization. Finding a New Normal consisted of four major themes: (1) Processing PICU Reminders and Memories, (2) Changing Perceptions of Health and Illness, (3) We Are Not the Same, and (4) Altered Relationships. Participants described significant emotional and behavioral changes during the year following discharge. The psychological impact of individual family members' experiences led to changes in their sense of self, which affected family dynamics. PICU memories and reminders impacted participants' perceptions of childhood health and illness and resulted in increased vigilance. Parents and siblings demonstrated increased concern for the child survivor's health, and the experience of long absences and new or altered caregiving roles resulted in changes in relationships and family dynamics. Conclusion: PICU hospitalization impacted the psychological well-being of all family members as they sought to re-establish a sense of normalcy one year following discharge. Parent and child experiences and responses were closely interconnected. Findings highlight the importance of increased follow-up care aimed at supporting the family's psychological recovery.
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Affiliation(s)
- Janet E Rennick
- Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre (MUHC), Montreal, QC, Canada.,Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada
| | - Alyssa M Knox
- Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada
| | - Stephanie C Treherne
- Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada
| | - Karen Dryden-Palmer
- Department of Critical Care, Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Stremler
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience and Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Lyndsey McRae
- Department of Neurosciences and Trauma, Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle Ho
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Division of Paediatric Medicine, Complex Care Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Dale M Stack
- Department of Psychology and Centre for Research in Human Development, Concordia University, Montreal, QC, Canada
| | - Geoffrey Dougherty
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada.,Department of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Hailey Fudge
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Department of Nursing and Department of Pediatrics, IWK Health, Halifax, NS, Canada
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29
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Fergé JL, Banydeen R, Le Terrier C, Fize H, Miguel M, Kentish-Barnes N, Jehel L, Moroy A, Valentino R, Mehdaoui H. Mental Health of Adolescent Relatives of Intensive Care Patients: Benefits of an Open Visitation Policy. Am J Crit Care 2021; 30:72-76. [PMID: 33385205 DOI: 10.4037/ajcc2021799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Symptoms of anxiety and depression are common in adolescents with a loved one in an intensive care unit (ICU) and are known precursors of posttraumatic stress disorder (PTSD). OBJECTIVES To assess the prevalence of PTSD and associated factors in adolescent (age 12-17 years) relatives of patients in an ICU with an open visitation policy. METHODS One year after the patient was discharged from the ICU, eligible adolescent relatives completed a satisfaction survey, anxiety history questionnaire, and psychometric evaluations (Hospital Anxiety and Depression Scale and 8-item Children's Revised Impact of Event Scale). RESULTS Thirty-two patients intubated for >2 days and with a Simplified Acute Physiology Score II >30 were included. Forty-six adolescents with first- to third-degree relationships to the patient, and in regular contact (≥monthly) with the patient before hospitalization, were enrolled. The prevalence of PTSD among the adolescents was 33%. Adolescents who visited the ICU were less likely to report feelings of regret than those who did not visit the ICU (2% vs 9%, P = .01). A past sense of threat (odds ratio [95% CI], 19.4 [1.9-201.2]; P = .01) and anxiety and depression symptoms (odds ratio [95% CI], 9.6 [1.4-63.7]; P = .02) were independent factors associated with probable PTSD. CONCLUSIONS A cautiously prepared open visiting policy should be maintained for adolescents with a relative in the ICU, because it could prevent feelings of regret and subsequent PTSD. Adolescents with risk factors should be screened and followed up.
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Affiliation(s)
- Jean-Louis Fergé
- Jean-Louis Fergé is an anesthesiologist-intensivist, Intensive Care Unit, CHU Martinique (Centre Hospitalier Universitaire de Martinique), Fort-de-France, France
| | - Rishika Banydeen
- Rishika Banydeen is an epidemiologist-research methodologist, Clinical Research Department, CHU Martinique
| | - Christophe Le Terrier
- Christophe Le Terrier is an intensivist, Intensive Care Unit, CHU Martinique (Centre Hospitalier Universitaire de Martinique), Fort-de-France, France
| | - Hélène Fize
- Helene Fize is a general practitioner, Regional Union of Liberal Doctors of Martinique, Fort-de-France, France
| | - Mathurina Miguel
- Mathurina Miguel is a general practitioner, Regional Union of Liberal Doctors of Martinique, Fort-de-France, France
| | - Nancy Kentish-Barnes
- Nancy Kentish-Barnes is a sociologist, Famiréa Research Group, Saint-Louis University Hospital, Paris, France
| | - Louis Jehel
- Louis Jehel is a psychiatrist, Psychiatric Unit, CHU Martinique
| | - Anne Moroy
- Anne Moroy is a psychiatrist, Psychiatric Unit, National Resource and Resilience Center, Lille, France
| | - Ruddy Valentino
- Ruddy Valentino is an intensivist, Intensive Care Unit, CHU Martinique (Centre Hospitalier Universitaire de Martinique), Fort-de-France, France
| | - Hossein Mehdaoui
- Hossein Mehdaoui is an intensivist, Intensive Care Unit, CHU Martinique (Centre Hospitalier Universitaire de Martinique), Fort-de-France, France
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30
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Living with the Memories-Parents' Experiences of Their Newborn Child Undergoing Heart Surgery Abroad: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238840. [PMID: 33260688 PMCID: PMC7730968 DOI: 10.3390/ijerph17238840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022]
Abstract
Parents of children with a congenital heart defect needing complex heart surgery are at high risk of developing health problems. One can assume that parents whose child undergoes heart surgery abroad will undoubtably face added and unique stressors and health vulnerabilities. The aim of this qualitative study was to explore the transition experiences of parents of children who underwent a complex heart surgery abroad as newborns 1–5 years ago. The qualitative content analysis methodology by Graneheim and Lundman was used. A purposive sample of twelve parents, whose child had undergone a heart surgery abroad, participated in face-to-face, semi-structured interviews. Interviews were transcribed and analyzed using inductive qualitative content analysis. The overarching theme of “living with the memories” emerged from parents’ experiences, emphasizing the long-lasting impact this stressful event had on their lives. These experiences were characterized by four main categories: (1) being in an unknown situation; (2) feeling connected; (3) wishing to be accepted; and (4) finding closure. The findings show that the transition of having a newborn child undergo heart surgery abroad superimposed on the expected parenthood. That parents need to feel connected and included as legitimate clients was highlighted in their stories of experienced vulnerabilities. The results highlight the need for interdisciplinary teams to support these vulnerable families, particularly with follow-up care.
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31
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The Tip of an Iceberg? A "Big Data" Study Examines the Evidence for New Mental Health Problems in Parents After PICU. Pediatr Crit Care Med 2020; 21:1002-1003. [PMID: 33136986 DOI: 10.1097/pcc.0000000000002588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Barnes S, Broom M, Jordan Z. Incidence and prevalence of acute stress disorder and post-traumatic stress disorder in parents of children hospitalized in intensive care units: a systematic review protocol. JBI Evid Synth 2020; 19:236-241. [PMID: 32868710 DOI: 10.11124/jbies-20-00080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this review is to determine the incidence and prevalence of acute stress disorder and post-traumatic stress disorder in parents who have a child hospitalized in an intensive care unit. INTRODUCTION Having a child admitted to an intensive care unit is known to be challenging and stressful for parents. This stress may lead to clinical stress disorders that may be improved through interventions. However, there is insufficient clarity around the incidence and prevalence of these disorders. INCLUSION CRITERIA This review will consider studies of parents who have had a child admitted to a neonatal or pediatric intensive care unit and who have developed associated acute stress disorder or post-traumatic stress disorder related to their child's hospitalization. METHODS The proposed review will follow JBI methodology for systematic reviews of prevalence and incidence. A strategic search for eligible studies will include multiple database sources and unpublished literature. Studies will be assessed for inclusion by two independent reviewers based initially on study titles and abstracts, and subsequently on full text. Methodological quality will be assessed by two independent reviewers, with inclusion criteria focusing on sampling and statistical analysis. Data extraction will be completed, and data synthesis will pool data where possible. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO (CRD42020190875).
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Affiliation(s)
- Shannon Barnes
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Margaret Broom
- Neonatal Intensive Care Unit, Centenary Hospital for Women and Children, ACT Health, Canberra, ACT, Australia.,Australian Catholic University, Canberra, ACT, Australia
| | - Zoe Jordan
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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33
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Adetunji O, Ottino K, Tucker A, Al-Attar G, Abduljabbar M, Bishai D. Variations in pediatric hospitalization in seven European countries. Health Policy 2020; 124:1165-1173. [PMID: 32739031 DOI: 10.1016/j.healthpol.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare rates of pediatric hospital utilization across seven European countries. METHODS Secondary data from WHO's European Hospital Morbidity Database from 2009 to 2012. Cross- country comparison of rates of admissions and bed days per 100 person-years by clinical service. We tabulated counts of admissions and bed days by principal diagnosis and age group for Ireland, Austria, Hungary, Belgium, Spain, Germany, and France. ICD 9 or ICD 10 or ISHMT diagnosis codes were allocated to clinical services. Normal newborn admissions were excluded from the analysis. Simple linear regression models, weighted by pediatric population size, were constructed to estimate the relationships between health care utilization and factors that may influence variation in care. RESULTS Hospital admission across the seven countries ranged from 9.41 (Spain) to 19.59 (Germany) admissions per 100 person-years. Bed days ranged from a low of 52.50 (Spain) to 135.44 (Germany) per 100 person-years. General pediatrics and neonatology led in clinical volume across all countries. Infectious disease admissions were the third most common. Bed supply and nurse supply were positively associated with health care utilization. Out-of-pocket payment was inversely associated with health care utilization CONCLUSIONS: A wide range of utilization of pediatric inpatient care was observed across seven European countries that have universal coverage. Variation in the provision of effective, supply-sensitive, and preference-sensitive care may explain some of the variations. Our study shows that it is probable that preventable hospital admissions are occurring in the pediatric population.
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Affiliation(s)
- Oluwarantimi Adetunji
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
| | - Kevin Ottino
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
| | - Austin Tucker
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
| | | | | | - David Bishai
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States.
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Hartman ME, Williams CN, Hall TA, Bosworth CC, Piantino JA. Post-Intensive-Care Syndrome for the Pediatric Neurologist. Pediatr Neurol 2020; 108:47-53. [PMID: 32299742 PMCID: PMC7306429 DOI: 10.1016/j.pediatrneurol.2020.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 12/17/2022]
Abstract
The number of children who survive critical illness has steadily increased. However, lower mortality rates have resulted in a proportional increase in post-intensive-care morbidity. Critical illness in childhood affects a child's development, cognition, and family functioning. The constellation of physical, emotional, cognitive, and psychosocial symptoms that begin in the intensive care unit and continue after discharge has recently been termed post-intensive-care syndrome. A conceptual model of the post-intensive-care syndrome experienced by children who survive critical illness, their siblings, and parents has been coined post-intensive-care syndrome in pediatrics. Owing to their prolonged hospitalizations, the use of sedative medications, and the nature of their illness, children with primary neurological injury are among those at the highest risk for post-intensive-care syndrome in pediatrics. The pediatric neurologist participates in the care of children with acute brain injury throughout their hospitalization and remains involved after the patient leaves the hospital. Hence it is important for pediatric neurologists to become versed in the early recognition and management of post-intensive-care syndrome in pediatrics. In this review, we discuss the current knowledge regarding post-intensive-care syndrome in pediatrics and its risk factors. We also discuss our experience establishing Pediatric Neurocritical Care Recovery Programs at two large academic centers. Last, we provide a battery of validated tests to identify and manage the different aspects of post-intensive-care syndrome in pediatrics, which have been successfully implemented at our institutions. Dissemination of this "road map" may assist others interested in establishing recovery programs, therefore mitigating the burden of post-intensive-care morbidity in children.
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Affiliation(s)
- Mary E. Hartman
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis, MO
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University,Department of Pediatrics, Division of Pediatric Critical care, Oregon Health & Science University
| | - Trevor A. Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Christopher C. Bosworth
- Department of Psychology, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | - Juan A. Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University,Department of Pediatrics, Division of Pediatric Neurology, Oregon Health & Science University
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Abstract
PURPOSE OF REVIEW Children with medical or surgical critical illness or injury require skillful attention to physical, emotional, psychological, and spiritual needs, whereas their families need support and guidance in facing life-threatening or life-changing events and gut-wrenching decisions. This article reviews current evidence and best practices for integrating palliative care into the pediatric intensive care unit (PICU), with a focus on surgical patients. RECENT FINDINGS Palliative care is best integrated in a tiered approach, with primary palliative care provided by the PICU and surgical providers for all patients and families, including basic symptom management, high-quality communication, and end-of-life care. Secondary and tertiary levels of care involve unit or team-based 'champions' with additional expertise, and subspecialty palliative care teams, respectively. PICU and surgical providers should be able to provide primary palliative care, to identify patients and families for whom a palliative care consult would be helpful, and should be comfortable introducing the concept of palliative care to families. SUMMARY This review provides a framework and tools to enable PICU and surgical providers to integrate palliative care best practices into patient and family care.
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McMahon E, Chang YS. From Surviving to Thriving - Parental Experiences of Hospitalised Infants with Congenital Heart Disease Undergoing Cardiac Surgery: A Qualitative Synthesis. J Pediatr Nurs 2020; 51:32-41. [PMID: 31884242 DOI: 10.1016/j.pedn.2019.12.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/15/2019] [Accepted: 12/15/2019] [Indexed: 12/27/2022]
Abstract
PROBLEM Congenital heart disease (CHD) is the most common congenital abnormality in infants and over one third of these infants will require surgical intervention in the neonatal period. This qualitative synthesis aimed to explore parental experiences of surgery and hospitalisation in the intensive care environment for the treatment of their infant's CHD in the first year of life in order to inform practice. ELIGIBILITY CRITERIA Qualitative primary research and qualitative elements of mixed methods studies published in English between January 2009 and February 2019 were eligible if they addressed the experiences and perspectives of parents whose infants had CHD undergoing cardiac surgery in the first year of life. SAMPLE Three hundred and forty-nine papers were screened. Six papers, with three of them from the same larger study, were included. RESULTS Five themes were developed from thematic synthesis. They are (1) intense conflicting emotions from heartbreak to joy, (2) the helplessness and uncertainty of waiting, (3) making sense of it all, (4) the power of relationships, and (5) parenting despite the challenges. CONCLUSION Parents experienced intense and fluctuating emotions, and found ways of coping. The integral role of healthcare professionals/nurses during this period was also evident. IMPLICATIONS Healthcare professionals/nurses have the potential to positively impact the care and outcomes for this growing population of infants with CHD and their families, helping them to thrive. More research is needed with longitudinal and multi-centred studies and in middle and low income counties to broaden our understanding of this topic.
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Affiliation(s)
- Emma McMahon
- Department of Child & Family Health, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Yan-Shing Chang
- Department of Child & Family Health, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
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Abela KM, Wardell D, Rozmus C, LoBiondo-Wood G. Impact of Pediatric Critical Illness and Injury on Families: An Updated Systematic Review. J Pediatr Nurs 2020; 51:21-31. [PMID: 31874458 DOI: 10.1016/j.pedn.2019.10.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 01/28/2023]
Abstract
PROBLEM Pediatric ICUs (PICU) that have adopted family-centered care models welcome families to the critically ill child's bedside to partner with clinicians in decision-making and the provision of care. The aim of this review was to synthesize the evidence on the impact of critical illness and injury on families of children admitted to the PICU to identify research needs in pediatric critical care. ELIGIBILITY CRITERIA This systematic review included quantitative and qualitative studies that examined the experiences of families of children admitted to a PICU published between 2005 and 2019. SAMPLE 33 articles were selected for inclusion in the final analysis after screening those identified by searches in CINAHL, PubMed, PsycINFO, and reference lists of included publications. RESULTS Main parental stressors included the sights and sounds within the PICU, child acuity, changes to family functioning and parenting role, and uncertainty of the child's outcome. The most common need of parents was to be well-informed. Psychological, physical, and social impact of hospitalization were experienced by parents from days after admission to years after discharge. Spirituality was identified as a coping mechanism in half of the studies. CONCLUSIONS Parents experience negative effects of the ill child's admission to the PICU and to PICU exposure. IMPLICATIONS Careful consideration of the impact of the PICU admission on family members of critically ill or injured children is needed when implementing family-centered care strategies. Future research on other family members including the healthy sibling needs to be conducted.
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Affiliation(s)
- Karla M Abela
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, United States of America.
| | - Diane Wardell
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, United States of America
| | - Cathy Rozmus
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, United States of America
| | - Geri LoBiondo-Wood
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, United States of America
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Williams CN, Hartman ME, Guilliams KP, Guerriero RM, Piantino JA, Bosworth CC, Leonard SS, Bradbury K, Wagner A, Hall TA. Postintensive Care Syndrome in Pediatric Critical Care Survivors: Therapeutic Options to Improve Outcomes After Acquired Brain Injury. Curr Treat Options Neurol 2019; 21:49. [PMID: 31559490 DOI: 10.1007/s11940-019-0586-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Children surviving the pediatric intensive care unit (PICU) with neurologic illness or injury have long-term morbidities in physical, cognitive, emotional, and social functioning termed postintensive care syndrome (PICS). In this article, we review acute and longitudinal management strategies available to combat PICS in children with acquired brain injury. RECENT FINDINGS Few intervention studies in this vulnerable population target PICS morbidities. Small studies show promise for both inpatient- and outpatient-initiated therapies, mainly focusing on a single domain of PICS and evaluating heterogeneous populations. While evaluating the effects of interventions on longitudinal PICS outcomes is in its infancy, longitudinal clinical programs targeting PICS are increasing. A multidisciplinary team with inpatient and outpatient presence is necessary to deliver the holistic integrated care required to address all domains of PICS in patients and families. While PICS is increasingly recognized as a chronic problem in PICU survivors with acquired brain injury, few interventions have targeted PICS morbidities. Research is needed to improve physical, cognitive, emotional, and social outcomes in survivors and their families.
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Affiliation(s)
- Cydni N Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA.
- Department of Pediatrics, Division of Pediatric Critical Care, Oregon Health and Science University, Portland, OR, USA.
| | - Mary E Hartman
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Kristin P Guilliams
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Rejean M Guerriero
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Juan A Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA
- Department of Pediatrics, Division of Pediatric Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Christopher C Bosworth
- Department of Psychology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Skyler S Leonard
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Kathryn Bradbury
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Amanda Wagner
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Trevor A Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
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Early Interventions for the Prevention of Posttraumatic Stress Symptoms in Survivors of Critical Illness: A Qualitative Systematic Review. Crit Care Med 2019; 46:1328-1333. [PMID: 29794546 DOI: 10.1097/ccm.0000000000003222] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Posttraumatic stress disorder among survivors of critical illness is of public health importance, as it is common and reduces patient quality of life. The objective of this systematic review was to collate the world's literature on interventions aimed at preventing posttraumatic stress disorder among survivors of critical illness. DATA SOURCES We performed a search of CENTRAL, MEDLINE, EMBASE, CINAHL, and clinical trials registry platforms, with no restriction to language using a comprehensive strategy. STUDY SELECTION Study inclusion criteria were as follows: 1) adult human subjects, 2) patients treated in an ICU setting, 3) intervention arm aimed at reducing posttraumatic stress disorder symptoms, 4) use of a control arm, and 5) an outcome measure assessing development of acute stress or posttraumatic stress disorder symptoms. DATA EXTRACTION We performed a qualitative analysis to collate and summarize effects of identified interventions according to the recommended methodology from the Cochrane Handbook. DATA SYNTHESIS Seventeen studies met all inclusion and no exclusion criteria. There was heterogeneity in interventions and outcome measures used. All studies had some concern for risk of bias as per the Cochrane tool for assessing risk of bias. In eight of 12 studies (67%) testing early interventions (i.e., initiated in the ICU course) and one of five studies (20%) testing delayed interventions following ICU discharge, posttraumatic stress disorder symptoms were decreased among the intervention group compared with controls. CONCLUSIONS Despite a paucity of high-quality clinical investigations, the preponderance of evidence to date suggests that 1) posttraumatic stress disorder among survivors of critical illness may be preventable and 2) early interventions may be the most effective.
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Parent Medical Traumatic Stress and Associated Family Outcomes After Pediatric Critical Illness: A Systematic Review. Pediatr Crit Care Med 2019; 20:759-768. [PMID: 31107380 DOI: 10.1097/pcc.0000000000001985] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To critically review, analyze, and synthesize the literature on parent medical traumatic stress from a child's critical illness requiring PICU admission and its association with outcomes of parent mental and physical health, and family functioning. DATA SOURCES Systematic literature search of Pubmed, Embase, CINAHL, and PsychInfo. STUDY SELECTION Two reviewers identified peer-reviewed published articles with the following criteria: 1) published between January 1, 1980, and August 1, 2018; 2) published in English; 3) study population of parents of children with a PICU admission; and 4) quantitative studies examining factors associated with outcomes of parent mental health, parent physical health, or family functioning. DATA EXTRACTION Literature search yielded 2,476 articles, of which 23 studies met inclusion criteria. Study data extracted included study characteristics, descriptive statistics of parent outcomes after critical illness, and variables associated with parent and family outcomes. DATA SYNTHESIS Studies examined numerous variables associated with parent and family outcomes and used multiple survey measures. These variables were categorized according to their phase in the Integrative Trajectory Model of Pediatric Medical Traumatic Stress, which included peri-trauma, acute medical care, and ongoing care or discharge from care. The majority of objective elements of a child's illness, such as severity of illness and length of hospitalization, did not have a clear relationship with parent and family outcomes. However, familial preexisting factors, a parent's subjective experience in the PICU, and family life stressors after discharge were often associated with parent and family outcomes. CONCLUSIONS This systematic literature review suggests that parent and family outcomes after pediatric critical illness are impacted by familial preexisting factors, a parent's subjective experience in the PICU, and family life stressors after discharge. Developing parent interventions focused on modifying the parent's subjective experience in the PICU could be an effective approach to improve parent outcomes.
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Treble-Barna A, Beers SR, Houtrow AJ, Ortiz-Aguayo R, Valenta C, Stanger M, Chrisman M, Orringer M, Smith CM, Pollon D, Duffett M, Choong K, Watson RS, Kochanek PM, Fink EL. PICU-Based Rehabilitation and Outcomes Assessment: A Survey of Pediatric Critical Care Physicians. Pediatr Crit Care Med 2019; 20:e274-e282. [PMID: 30946294 PMCID: PMC7132781 DOI: 10.1097/pcc.0000000000001940] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Characterize current practices for PICU-based rehabilitation, and physician perceptions and attitudes, barriers, resources, and outcome assessment in contemporary PICU settings. DESIGN International, self-administered, quantitative, cross-sectional survey. SETTING Online survey distributed from March 2017 to April 2017. PATIENTS OR SUBJECTS Pediatric critical care physicians who subscribed to email distribution lists of the Pediatric Acute Lung Injury and Sepsis Investigators, the Pediatric Neurocritical Care Research Group, or the Prevalence of Acute Critical Neurological Disease in Children: A Global Epidemiological Assessment study group, and visitors to the World Federation of Pediatric Intensive and Critical Care Societies website. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 170 subjects who began the survey, 148 completed it. Of those who completed the optional respondent information, most reported working in an academic medical setting and were located in the United States. The main findings were 1) a large majority of PICU physicians reported working in institutions with no guidelines for PICU-based rehabilitation, but expressed interest in developing and implementing such guidelines; 2) despite this lack of guidelines, an overwhelming majority of respondents reported that their current practices would involve consultation of multiple rehabilitation services for each case example provided; 3) PICU physicians believed that additional research evidence is needed to determine efficacy and optimal implementation of PICU-based rehabilitation; 4) PICU physicians reported significant barriers to implementation of PICU-based rehabilitation across centers; and 5) low routine assessment of long-term functional outcomes of PICU patients, although some centers have developed multidisciplinary follow-up programs. CONCLUSIONS Physicians lack PICU-based rehabilitation guidelines despite great interest and current practices involving a high degree of PICU-based rehabilitation consultation. Data are needed to identify best practices and necessary resources in the delivery of ICU-based multidisciplinary rehabilitation and long-term functional outcomes assessment to optimize recovery of children and families affected by critical illness.
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Affiliation(s)
- Amery Treble-Barna
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sue R. Beers
- Departments of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Pittsburgh, PA, USA
| | - Amy J. Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Roberto Ortiz-Aguayo
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cynthia Valenta
- Professional Practice and Education, Jefferson Hospital, Jefferson Hills, PA, USA
| | - Meg Stanger
- Department of Physical Therapy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Maddie Chrisman
- Department of Physical Therapy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Maxine Orringer
- Audiology Communications Disorders, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Craig M. Smith
- Division of Critical Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Dorothy Pollon
- Special Needs Child Advocate and Study Stakeholder, Pittsburgh, PA, USA
| | - Mark Duffett
- Departments of Pediatrics and Critical Care, McMaster University, Hamilton, ON, Canada
| | - Karen Choong
- Departments of Pediatrics and Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - R. Scott Watson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Patrick M. Kochanek
- Department of Critical Care Medicine, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ericka L. Fink
- Department of Critical Care Medicine, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Liaw KRL, Cho J, Devins L, Daly J, Sklenar D, Al-Qaqaa Y. Co-designed PICU Family Stress Screening and Response System to Improve Experience, Quality, and Safety. Pediatr Qual Saf 2019; 4:e145. [PMID: 31321362 PMCID: PMC6494229 DOI: 10.1097/pq9.0000000000000145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/22/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Evidence for successful and sustainable models that systematically identify and address family stress in the pediatric intensive care unit (PICU) remains scarce. Using an integrated improvement science and family engagement framework, we implemented a standardized family stress screening tool and response protocol to improve family experience and reduce family crises through the timely coordination of parent support interventions. METHODS We conducted this improvement initiative in the 12-bed PICU of a children's hospital within a large, urban academic medical center. Our team, which included 2 family advisors, adapted a validated Distress Thermometer for use in pediatric intensive care. A co-designed family stress screening tool and response protocol were iteratively tested, refined, and implemented in 2015-2017. Process and outcome measures included screening and response reliability, parent satisfaction, and security calls for distressed families. RESULTS Over the 18 months, the percentage of families screened for stress increased from 0% to 100%. Among families who rated stress levels ≥5, 100% received the recommended response protocol, including family support referrals made and completed within 24 hours of an elevated stress rating. From 2015 to 2017, PICU parent satisfaction scores regarding emotional support increased from a mean score of 81.7-87.0 (P < 0.01; 95% CI). The number of security calls for distressed families decreased by 50%. CONCLUSIONS The successful implementation of a co-designed family stress screening tool and response protocol led to the timely coordination of parent support interventions, the improved family perception of emotional support, and reduced family crises in the PICU.
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Affiliation(s)
- K Ron-Li Liaw
- Sala Institute for Child And Family Centered Care, NYU Langone Health, New York, N.Y
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, N.Y
| | - Jeanne Cho
- Sala Institute for Child And Family Centered Care, NYU Langone Health, New York, N.Y
| | - Lea Devins
- Department of Nursing, NYU Langone Health, New York, N.Y
| | - Jennifer Daly
- Sala Institute for Child And Family Centered Care, NYU Langone Health, New York, N.Y
| | - Dennis Sklenar
- Department of Social Work, NYU Langone Health, New York, N.Y
| | - Yasir Al-Qaqaa
- Department of Pediatrics, NYU School of Medicine, New York, N.Y
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Van den Berghe G. Paediatric critical care survival: how to avoid bias. THE LANCET RESPIRATORY MEDICINE 2018; 7:e2. [PMID: 30467099 DOI: 10.1016/s2213-2600(18)30408-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 09/27/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Greet Van den Berghe
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, B-3000 Leuven, Belgium.
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Interventions to Reduce Psychologic Morbidity After PICU Discharge: Challenges to Establishing Efficacy. Pediatr Crit Care Med 2017; 18:387-388. [PMID: 28376006 PMCID: PMC5382805 DOI: 10.1097/pcc.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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