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Posttraumatic Stress Disorder in Critical Illness Survivors: A Metaanalysis*

Parker, Ann M. MD1,2; Sricharoenchai, Thiti MD3; Raparla, Sandeep MD4; Schneck, Kyle W. BA5; Bienvenu, O. Joseph MD, PhD2,6; Needham, Dale M. FCA, MD, PhD1,2,7

doi: 10.1097/CCM.0000000000000882
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Objective: To conduct a systematic review and metaanalysis of the prevalence, risk factors, and prevention/treatment strategies for posttraumatic stress disorder symptoms in critical illness survivors.

Data Sources: PubMed, Embase, CINAHL, PsycINFO, and Cochrane Library from inception through March 5, 2014.

Study Selection: Eligible studies met the following criteria: 1) adult general/nonspecialty ICU, 2) validated posttraumatic stress disorder instrument greater than or equal to 1 month post-ICU, and 3) sample size greater than or equal to 10 patients.

Data Extraction: Duplicate independent review and data abstraction from all eligible titles/abstracts/full-text articles.

Data Synthesis: The search identified 2,817 titles/abstracts, with 40 eligible articles on 36 unique cohorts (n = 4,260 patients). The Impact of Event Scale was the most common posttraumatic stress disorder instrument. Between 1 and 6 months post-ICU (six studies; n = 456), the pooled mean (95% CI) Impact of Event Scale score was 20 (17–24), and the pooled prevalences of clinically important posttraumatic stress disorder symptoms (95% CI) were 25% (18–34%) and 44% (36–52%) using Impact of Event Scale thresholds greater than or equal to 35 and greater than or equal to 20, respectively. Between 7 and 12 months post-ICU (five studies; n = 698), the pooled mean Impact of Event Scale score was 17 (9–24), and pooled prevalences of posttraumatic stress disorder symptoms were 17% (10–26%) and 34% (22–50%), respectively. ICU risk factors for posttraumatic stress disorder symptoms included benzodiazepine administration and post-ICU memories of frightening ICU experiences. Posttraumatic stress disorder symptoms were associated with worse quality of life. In European-based studies: 1) an ICU diary was associated with a significant reduction in posttraumatic stress disorder symptoms, 2) a self-help rehabilitation manual was associated with significant posttraumatic stress disorder symptom reduction at 2 months, but not 6 months; and 3) a nurse-led ICU follow-up clinic did not reduce posttraumatic stress disorder symptoms.

Conclusions: Clinically important posttraumatic stress disorder symptoms occurred in one fifth of critical illness survivors at 1-year follow-up, with higher prevalence in those who had comorbid psychopathology, received benzodiazepines, and had early memories of frightening ICU experiences. In European studies, ICU diaries reduced posttraumatic stress disorder symptoms.

Supplemental Digital Content is available in the text.

1Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

2Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD.

3Division of Pulmonary and Critical Care Medicine, Thammasat University, Pathum Thani, Thailand.

4Department of Internal Medicine, Good Samaritan Hospital, Baltimore, MD.

5Department of Linguistics and Cognitive Science, University of Delaware, Newark, DE.

6Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD.

7Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.

*See also p. 1151.

This work was performed at Johns Hopkins University.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Parker received support for article research from the National Institutes of Health (NIH; T32HL007534-31 and 1KL2TR001077). Her institution received grant support from the NIH (Dr. Parker received salary funding through an NIH T32 grant and an NIH KL2 grant. Dr. Needham’s institution received grant support from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: aparke36@jhu.edu

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