Long‐term psychosocial impact reported by childhood critical illness survivors: a systematic review

Abstract

AimTo undertake a qualitative systematic review that explores psychological and social impact, reported directly from children and adolescents at least 6 months after their critical illness.BackgroundSignificant advances in critical care have reduced mortality from childhood critical illness, with the majority of patients being discharged alive. However, it is widely reported that surviving critical illness can be traumatic for both children and their family. Despite a growing body of literature in this field, the psychological and social impact of life threatening critical illness on child and adolescent survivors, more than 6 months post event, remains under-reported.Data sourcesSearches of six online databases were conducted up to February 2012.Review methodsPredetermined criteria were used to select studies. Methodological quality was assessed using a standardized checklist. An adapted version of the thematic synthesis approach was applied to extract, code and synthesize data.FindingsThree studies met the inclusion criteria, which were all of moderate methodological quality. Initial coding and synthesis of data resulted in five descriptive themes: confusion and uncertainty, other people's narratives, focus on former self and normality, social isolation and loss of identity, and transition and transformation. Further synthesis culminated in three analytical themes that conceptualize the childhood survivors' psychological and social journey following critical illness.ConclusionsCritical illness in childhood can expose survivors to a complex trajectory of recovery, with enduring psychosocial adversity manifesting in the long term. Nurses and other health professionals must be aware and support the potential multifaceted psychosocial needs that may arise. Parents and families are identified as fundamental in shaping psychological and social well-being of survivors. Therefore intensive care nurses must take opportunities to raise parents' awareness of the journey of survival and provide appropriate support. Further empirical research is warranted to explore the deficits identified with the existing literature.

Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs*

“…Repeated illness and unplanned PICU admissions can lead to physical and psychological morbidity for patients and considerable stress for families (8–10). For institutions, lengthy unplanned PICU readmissions may be obstacles to hospital efficiency, potentially delaying admissions of other critically ill patients or patients needing major elective surgeries.…”

“…Unplanned readmissions are a focus of healthcare quality measurement, as they may be preventable (3) and are associated with worse outcomes (4–5) and higher costs (6–7). Furthermore, repeated critical illness and hospitalization negatively impact patients and families (8–10). Except for a few studies focused on early readmissions (4) and readmissions during the same hospitalization (11–13), it is not known how often unplanned PICU readmissions occur and who are at most risk.…”

Protocol for a longitudinal qualitative study: survivors of childhood critical illness exploring long-term psychosocial well-being and needs—The SCETCH Project

“…Thematic synthesis does provide an insight into the potential multifaceted and complex transformations that children and adolescents can encounter. However, it is unclear whether the outcomes are isolated to specific times, or they are present throughout the experience of survival, or whether and how they may change over time 38. In addition, it is also uncertain whether there is an interplay between the reports and perceptions of significant others in survivors’ lives (eg, parents, siblings or teachers) and whether or how these may influence survivors' well-being.…”

Early Mobilization in Critically Ill Children: A Systematic Review

“…[1][2][3] These complications significantly impact the functional recovery and quality of life of critically ill children and their families after hospital discharge. 4,5 As a result, there is great interest in acute rehabilitation interventions initiated in the intensive care unit (ICU) setting for both children and adults. There is a growing body of evidence demonstrating safety, efficacy, and cost effectiveness of early mobilization in critically ill adults.…”