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Identifying children at high risk for psychological sequelae after pediatric intensive care unit hospitalization*

Rennick, Janet E., RN, PhD; Morin, Isabelle, MSc; Kim, Doris, MSc(A); Johnston, C. Celeste, RN, Ded; Dougherty, Geoffrey, MDCM, MSc, FRCPC; Platt, Robert, PhD

Pediatric Critical Care Medicine: July 2004 - Volume 5 - Issue 4 - p 358-363
doi: 10.1097/01.PCC.0000128603.20501.0D
CLINICAL INVESTIGATIONS
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Objective: To identify those patients in a pediatric intensive care unit who may be at highest risk for developing persistent psychological sequelae after hospital discharge.

Design: A secondary data analysis was conducted to examine data gathered in an earlier study of children's psychological responses after critical illness. The current study focused exclusively on patients who required pediatric intensive care unit hospitalization.

Patients: Sixty children, aged 6 to 17 yrs, hospitalized in two Canadian pediatric intensive care units.

Procedures: Children were categorized as either high risk or low risk for developing persistent psychological sequelae after discharge based on their level of illness severity and the number of invasive procedures to which they were exposed. Outcome data were analyzed using descriptive statistics, followed by an assessment of group differences at baseline, 6 wks, and 6 mos post-discharge. Combined effects of invasive procedures and illness severity on the outcome variables were explored.

Outcome Measures: Three questionnaires were completed by all children 6 wks and 6 mos postdischarge, including the Children's Impact of Events Scale, the Children's Medical Fears Scale, and the Children's Health Locus of Control Scale.

Results: Children in the high risk group demonstrated more psychological sequelae 6 wks and 6 mos postdischarge. Exposure to high numbers of invasive procedures was the most important predictor of group differences 6 wks postdischarge.

Conclusions: Findings suggest there is a group of children in the pediatric intensive care unit who are at higher risk for developing persistent psychological sequelae postdischarge. Exposure to high numbers of invasive procedures may be the driving force behind group differences, particularly at 6 wks postdischarge. These children warrant closer observation and follow-up.

From the Department of Nursing Research (JER) and the Intensive Ambulatory Care Service (GD), Montreal Children's Hospital of the McGill University Health Centre; the School of Nursing (JER, DK, CCJ) and the Departments of Pediatrics and Epidemiology and Biostatistics (GD, RP), McGill University; and the Biostatistics Consulting Service, Montreal Children's Hospital Research Institute of the McGill University Health Centre (IM, RP), Montreal, Quebec, Canada.

Supported, in part, by Fonds de la recherche en Santé du Québec (FRSQ 940718-103); the Canadian Nurses Foundation, Ottawa, Ontario, Canada; Ordre des infirmières et infirmiers du Québec; and The Montreal Children's Hospital Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.

Address requests for reprints to: Janet E. Rennick, RN, PhD, Nursing Research, Rm. A-412, The Montreal Children's Hospital of the McGill University Health Centre, 2300 Tupper Street, Montreal, Quebec, Canada H3H 1P3. E-mail: janet.rennick@muhc.mcgill.ca

©2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies