Development of an ICU discharge instrument predicting psychological morbidity: a multinational study

Abstract

PurposeTo develop an instrument for use at ICU discharge for prediction of psychological problems in ICU survivors.MethodsMultinational, prospective cohort study in ten general ICUs in secondary and tertiary care hospitals in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay ≥ 12 h were eligible for inclusion. Patients in need of neurointensive care, with documented cognitive impairment, unable to communicate in the local language, without a home address or with more than one limitation of therapy were excluded. Primary outcome was psychological morbidity 3 months after ICU discharge, defined as Hospital Anxiety and Depression Scale (HADS) subscale score ≥ 11 or Post-traumatic Stress Symptoms Checklist-14 (PTSS-14) part B score > 45.ResultsA total of 572 patients were included and 78% of patients alive at follow-up responded to questionnaires. Twenty percent were classified as having psychological problems post-ICU. Of 18 potential risk factors, four were included in the final prediction model after multivariable logistic regression analysis: symptoms of depression [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.10–1.50], traumatic memories (OR 1.44, 95% CI 1.13–1.82), lack of social support (OR 3.28, 95% CI 1.47–7.32) and age (age-dependent OR, peak risk at age 49–65 years). The area under the receiver operating characteristics curve (AUC) for the instrument was 0.76 (95% CI 0.70–0.81).ConclusionsWe developed an instrument to predict individual patients’ risk for psychological problems 3 months post-ICU, http://www.imm.ki.se/biostatistics/calculators/psychmorb/. The instrument can be used for triage of patients for psychological ICU follow-up.Trial registrationThe study was registered at clinicaltrials.gov, NCT02679157.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5467-3) contains supplementary material, which is available to authorized users.

Caregiver Burden and Emotional Wellbeing in Informal Caregivers to ICU Survivors: A Prospective Cohort Study

“…The ndings in our study indicate a need for management not only of the patient but also of the informal caregivers in follow-up after ICU stay, particularly caregivers to patients at high risk for persisting or newonset morbidity in the rst months post-ICU. Fairly accurate prediction of later physical or psychological problems in ICU survivors is possible [9,19]. High risk for incomplete recovery in an ICU survivor should alert follow-up teams that informal caregivers may have an increased risk for own problems.…”

“…We conducted a multicentre prospective observational cohort study as an a-priori planned sub study to a larger study [9], with four participating centres in tertiary care hospitals in Sweden. Adult cohabitants to ICU patients included in the larger study were approached and asked about study participation when visiting the ICU at times when research staff was available.…”

“…In contrast to several previous studies that restricted caregiver assessment to ICU patients being mechanically ventilated ≥48 hours or longer [20,21], we included informal caregivers to a broad group of ICU patients, admitted for 12 hours or longer to mixed medical-surgical ICUs in four different sized hospitals. This is a strength and increases generalizability, given that data do not support the notion that informal caregiver or patient outcomes are linked to the duration of mechanical ventilation or patients' ICU LOS [9,22].…”

Prevalence of Post Intensive Care Syndrome Among Japanese Intensive Care Unit Patients: A Prospective, Multicenter, Observational J-PICS Study

“…Multivariate logistic regression model was used to identify the factors associated with the occurrence of PICS. Multivariate analysis included the following variables as confounding factors: age, APACHE II score, CCI, and educational status [7,[45][46][47]. The risk of PICS is expressed as odds ratio (OR) with 95% con dence interval (CI).…”

Focus on long-term cognitive, psychological and physical impairments after critical illness

“…These studies identified several risk factors (e.g., socioeconomic status, pre-ICU health and employment, markers of brain injury, intensity of organ support, and length of ICU-stay) for development of cognitive, psychological, and physical sequelae and reduced HRQL after ARDS or other critical illness. The development of more precise instruments to predict neuropsychological or physical morbidity is needed [14] and, in the future, studies surviving patient's opinions regarding the decisions made during acute treatment should be integrated. In a prospective, longitudinal study conducted in 315 patients being weaned from prolonged ventilation at a long-term acute-care hospital [15] 84.7% of survivors indicated willingness to undergo mechanical ventilation again.…”