Objective: Annually, thousands of youths are admitted to pediatric intensive care units (PICUs) and are at increased risk for long-lasting neurocognitive and psychiatric sequelae, referred to as Post Intensive Care Syndrome (PICS). Research shows that youth with PICS strongly benefit from neuropsychological follow-up services; however, high proportions of referred patients (i.e., 25-33% at our hospital) do not attend follow-up appointments. The current study aims to better understand the barriers that hinder families’ abilities to access follow-up services. Method: Participants included guardians of children ages 0-18 years (N = 149) referred for follow-up neuropsychological assessment and did not attend the appointment. Data was collected via individual 10-minute structured telephone interviews focusing on treatment barriers chosen from prior research on social determinants of health. Participants identified the extent to which various barriers impacted appointment attendance. Results: Data collection is currently underway. Preliminary results demonstrate time limitations/scheduling difficulties and challenges related to the COVID-19 pandemic as the most frequent barriers to accessing treatment with 60% endorsement rates each. Relatedly, 50% reported difficulty taking time off from work. Several endorsed confusion surrounding the purpose of the appointment (40%), financial concerns (30%), family stress/mental health (30%), limited childcare (20%), transportation (10%), housing difficulties (10%), and language barriers (20%). Conclusion: Current findings highlight challenges that contribute to inequities in families’ access to care. These challenges represent important targets for interventions aimed at minimizing health care disparities. Such interventions hold promise for mitigating the extent to which PICS-related difficulties negatively impact youth’s social, psychological, and academic functioning following inpatient hospitalization.

Objective: Pediatric Intensive Care Unit (PICU) survivors are at elevated risk for developing neurocognitive concerns. Lower premorbid abilities, pediatric traumatic brain injury (pTBI) severity, and post-injury depression symptoms have been shown to predict greater neurocognitive deficits. However, limited extant research has focused on the acute recovery phase or used objective neuropsychological assessment measures. We examined the impact of pTBI severity and post-injury depression symptoms on neurocognitive functioning in the acute recovery phase. Method: Seventy-four trauma patients (8 to 19 years) were assessed 1-3 months after PICU discharge. Demographic and clinical data were extracted from the electronic medical record. Caregivers completed questionnaires about their children’s physical, cognitive and emotional functioning. The direct assessment included measures of WRAT5 word-reading; CMS/WISC-V/WAIS-IV digit span; WISC-V/WAIS-IV coding and symbol search; and DKEFS Trails-4, verbal phonemic and semantic fluencies. Given the high intercorrelations between aspects of executive function, principal components analysis (PCA) was conducted to create a cumulative neurocognitive index (NCI). A simple linear regression was used to test if moderate-severe Glasgow Coma scores and clinically elevated Promis Depression scores predicted NCI, controlling for reading ability. Results: Combining all participant data in the PCA yielded a single component solution accounting for 52.79% of total explained variance. The overall regression was significant (R2=.40), F(df=3,70) =15.23, p<.001. Elevated depression predicted NCI (p=.03) whereas greater pTBI severity was not predictive above the impact of premorbid factors. Conclusions: Neurocognitive functioning in PICU survivors within the acute recovery phase may be more related to concurrent depression symptoms than injury severity markers when premorbid factors are considered.

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