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Rawal H, Young DL, Nikooie R, Al Ani AH, Friedman LA, Vasishta S, Haut ER, Colantuoni E, Needham DM, Dinglas VD. Participant retention in trauma intensive care unit (ICU) follow-up studies: a post-hoc analysis of a previous scoping review. Trauma Surg Acute Care Open 2020; 5:e000584. [PMID: 33195814 PMCID: PMC7643521 DOI: 10.1136/tsaco-2020-000584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/24/2020] [Accepted: 10/14/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The study aimed to synthesize participant retention-related data for longitudinal follow-up studies of survivors from trauma intensive care units (ICUs). METHODS Within a published scoping review evaluating ICU patient outcomes after hospital discharge, two screeners independently searched for trauma ICU survivorship studies. RESULTS There were 11 trauma ICU follow-up studies, all of which were cohort studies. Twelve months (range: 1-60 months) was the most frequent follow-up time point for assessment (63% of studies). Retention rates ranged from 54% to 94% across time points and could not be calculated for two studies (18%). Pooled retention rates at 3, 6, and 12 months were 75%, 81%, and 81%, respectively. Mean patient age (OR 0.85 per 1-year increase, 95% CI 0.73 to 0.99, p=0.036), percent of men (OR 1.07, 95% CI 1.04 to 1.10, p=0.002), and publication year (OR 0.89 per 1-year increase, 95% CI 0.82 to 0.95, p=0.007) were associated with retention rates. Early (3-month) versus later (6-month, 12-month) follow-up time point was not associated with retention rates. DISCUSSION Pooled retention rates were >75%, at 3-month, 6-month, and 12-month time points, with wide variability across studies and time points. There was little consistency with reporting participant retention methodology and related data. More detailed reporting guidelines, with better author adherence, will help improve reporting of participant retention data. Utilization of existing research resources may help improve participant retention. LEVEL OF EVIDENCE Level III: meta-analyses (post-hoc analyses) of a prior scoping review.
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Affiliation(s)
- Himanshu Rawal
- Pulmonary Disease and Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Daniel L Young
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland, USA
| | - Roozbeh Nikooie
- Department of Internal Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Awsse H Al Ani
- MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Lisa Aronson Friedman
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland, USA
- PCCM, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sumana Vasishta
- Institute of Nephro Urology Mysuru Branch, Krishna Rajendra Hospital Campus, Mysuru, India
| | - Elliott R Haut
- Division of Acute Care Surgery, Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimmore, MD, United States
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland, USA
- PCCM, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland, USA
- PCCM, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Akhlaghi N, Needham DM, Bose S, Banner-Goodspeed VM, Beesley SJ, Dinglas VD, Groat D, Greene T, Hopkins RO, Jackson J, Mir-Kasimov M, Sevin CM, Wilson E, Brown SM. Evaluating the association between unmet healthcare needs and subsequent clinical outcomes: protocol for the Addressing Post-Intensive Care Syndrome-01 (APICS-01) multicentre cohort study. BMJ Open 2020; 10:e040830. [PMID: 33099499 PMCID: PMC7590359 DOI: 10.1136/bmjopen-2020-040830] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION As short-term mortality declines for critically ill patients, a growing number of survivors face long-term physical, cognitive and/or mental health impairments. After hospital discharge, many critical illness survivors require an in-depth plan to address their healthcare needs. Early after hospital discharge, numerous survivors experience inadequate care or a mismatch between their healthcare needs and what is provided. Many patients are readmitted to the hospital, have substantial healthcare resource use and experience long-lasting morbidity. The objective of this study is to investigate the gap in healthcare needs occurring immediately after hospital discharge and its association with hospital readmissions or death for survivors of acute respiratory failure (ARF). METHODS AND ANALYSIS In this multicentre prospective cohort study, we will enrol 200 survivors of ARF in the intensive care unit (ICU) who are discharged directly home from their acute care hospital stay. Unmet healthcare needs, the primary exposure of interest, will be evaluated as soon as possible within 1 to 4 weeks after hospital discharge, via a standardised telephone assessment. The primary outcome, death or hospital readmission, will be measured at 3 months after discharge. Secondary outcomes (eg, quality of life, cognitive impairment, depression, anxiety and post-traumatic stress disorder) will be measured as part of 3-month and 6-month telephone-based follow-up assessments. Descriptive statistics will be reported for the exposure and outcome variables along with a propensity score analysis, using inverse probability weighting for the primary exposure, to evaluate the relationship between the primary exposure and outcome. ETHICS AND DISSEMINATION The study received ethics approval from Vanderbilt University Medical Center Institutional Review Board (IRB) and the University of Utah IRB (for the Veterans Affairs site). These results will inform both clinical practice and future interventional trials in the field. We plan to disseminate the results in peer-reviewed journals, and via national and international conferences. TRIAL REGISTRATION DETAILS ClinicalTrials.gov (NCT03738774). Registered before enrollment of the first patient.
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Affiliation(s)
- Narjes Akhlaghi
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Somnath Bose
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Valerie M Banner-Goodspeed
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sarah J Beesley
- Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA
- Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Danielle Groat
- Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA
| | - Tom Greene
- Division of Epidemiology Biostatistics, University of Utah, Salt Lake City, UT, USA
| | - Ramona O Hopkins
- Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA
- Psychology and Neuroscience, Brigham Young University, Provo, UT, USA
| | - James Jackson
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mustafa Mir-Kasimov
- Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Carla M Sevin
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily Wilson
- Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA
| | - Samuel M Brown
- Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA
- Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Shima N, Miyamoto K, Shibata M, Nakashima T, Kaneko M, Shibata N, Shima Y, Kato S. Activities of daily living status and psychiatric symptoms after discharge from an intensive care unit: a single-center 12-month longitudinal prospective study. Acute Med Surg 2020; 7:e557. [PMID: 32995017 PMCID: PMC7507519 DOI: 10.1002/ams2.557] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 12/30/2022] Open
Abstract
AIM In post-intensive care syndrome (PICS), long-term survivors of critical illness present various physical and mental symptoms that can persist for years after discharge. Post-intensive care syndrome in Japan has not been well described, so this study aims to elucidate its epidemiology. METHODS We undertook a single-center prospective longitudinal cohort study in a mixed intensive care unit (ICU) in a Japanese tertiary hospital. Adult patients emergently admitted to the ICU were eligible for inclusion in the study. To assess activity of daily living (ADL) status and psychiatric symptoms, we posted a questionnaire at 3 and 12 months after discharge from the ICU. We evaluated ADL status, anxiety, depression, and post-traumatic stress disorder symptoms using the Barthel index, Hospital Anxiety and Depression Scale, and Impact of Event Scale - Revised, respectively. RESULTS Enrolled in this study were 204 patients. We received responses from 117/147 (80%) and 74/98 (76%) patients at 3 and 12 months, respectively. At 3 months, the prevalence of ADL disability, anxiety, depression, and post-traumatic stress disorder symptoms was 32%, 42%, 48%, and 20%, respectively. At 12 months, the prevalence was 22%, 33%, 39%, and 21%, respectively. The prevalence of any symptoms was 66% at 3 months and 55% at 12 months. Barthel index score at 12 months was improved significantly from that at 3 months. Hospital Anxiety and Depression Scale and Impact of Event Scale - Revised scores at 12 months showed no improvement. CONCLUSIONS At 3 and 12 months after ICU discharge, over half of our Japanese patients suffered ADL disability and/or psychiatric symptoms. The ADL disability improved at 1 year, but psychiatric symptoms did not.
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Affiliation(s)
- Nozomu Shima
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayama CityJapan
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayama CityJapan
| | - Mami Shibata
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayama CityJapan
| | - Tsuyoshi Nakashima
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayama CityJapan
| | - Masahiro Kaneko
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical UniversityWakayama CityJapan
| | - Naoaki Shibata
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayama CityJapan
| | - Yukihiro Shima
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayama CityJapan
| | - Seiya Kato
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayama CityJapan
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Abstract
PURPOSE OF REVIEW Evaluating longer term mortality, morbidity, and quality of life in survivors of critical illness is a research priority. This review details the challenges of long-term follow-up studies of critically ill patients and highlights recently proposed methodological solutions. RECENT FINDINGS Barriers to long-term follow-up studies of critical care survivors include high rates of study attrition because of death or loss to follow-up, data missingness from experienced morbidity, and lack of standardized outcome as well as reporting of key covariates. A number of recent methods have been proposed to reduce study patients attrition, including minimum data set selection and visits to transitional care or home settings, yet these have significant downsides as well. Conducting long-term follow-up even in the absence of such models carries a high expense, as personnel are very costly, and patients/families require reimbursement for their time and inconvenience. SUMMARY There is a reason why many research groups do not conduct long-term outcomes in critical care: it is very difficult. Challenges of long-term follow-up require careful consideration by study investigators to ensure our collective success in data integration and a better understanding of underlying mechanisms of mortality and morbidity seen in critical care survivorship.
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Affiliation(s)
- M. Elizabeth Wilcox
- Department of Medicine (Critical Care Medicine), Division of Respirology, University Health Network, Toronto, Canada
- Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - E. Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine and Center for Health Services Research, Department of Medicine, and the Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee
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