Risk Factors for Positive Post-Traumatic Stress Disorder Screening and Associated Outcomes in Children Surviving Acute Respiratory Failure: A Secondary Analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure Clinical Trial

Abstract

To identify risk factors and outcomes associated with a positive post-traumatic stress disorder (PTSD) screen following pediatric acute respiratory failure treated with invasive mechanical ventilation. DESIGN:Nonprespecified secondary analysis of a randomized clinical trial.SETTING: Thirty-one U.S. PICUs. PATIENTS:Children in the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial (NCT00814099, ClinicalTrials. gov) over 8 years old who completed PTSD screening 6 months after discharge.INTERVENTIONS: RESTORE sites were randomized to a targeted, nursedirected sedation strategy versus usual care. MEASUREMENTS AND MAIN RESULTS:PTSD screening was completed by 102 subjects using the Child Post-Traumatic Stress Disorder Symptom Scale; a score of greater than or equal to 11 was considered screening positive for PTSD. Cognitive status was categorized using Pediatric Cerebral Performance Category; health-related quality of life (HRQL) was evaluated using child-reported Pediatric Quality of Life Inventory, Version 4.0. Thirty-one children (30%) screened positive for PTSD. Children with a positive screen endorsed symptoms in all categories: reexperiencing, avoidance, and hyperarousal. Most endorsed that symptoms interfered with schoolwork (n = 18, 58%) and happiness (n = 17, 55%). Screening positive was not associated with RESTORE treatment group. In a multivariable logistic model adjusting for age, sex, and treatment group, screening positive was independently associated with lower median income in the family's residential zip code

Recent discoveries in preventing mental impairments and ICU staff interventions in post-intensive care syndrome

“…Analysis of a big randomized clinical trial in the pediatric population showed that screening positively for PTSD after a pediatric intensive care unit (PICU) stay was associated with lower income in the family's residential zip code, renal dysfunction and significant pain during hospitalization. Children screened positively for PTSD experienced a decrease in cognitive function and health-related quality of life [5]. Significantly, ICU stay is a factor that separately declines health-related quality of life [6,7,8].…”

Family Presence at the PICU Bedside: A Single-Center Retrospective Cohort Study*

“…P ediatric critical illness is associated with pain, anxiety, and delirium that may contribute to lower health-related quality of life (HRQL) and poor mental health outcomes after discharge (1)(2)(3). However, family presence during pediatric hospitalization may mitigate some of these adverse effects.…”