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Parental anxiety and medical comprehension within 24 hrs of a child's admission to the pediatric intensive care unit*

Needle, Jennifer S. MD, MPH; O’Riordan, MaryAnn MS; Smith, Paul G. DO

Pediatric Critical Care Medicine: November 2009 - Volume 10 - Issue 6 - p 668-674
doi: 10.1097/PCC.0b013e3181a706c9
Clinical Investigations

Objective: Admission of a child to the pediatric intensive care unit (PICU) can create high-parental anxiety. The authors examined the factors that contribute to parental anxiety and the effect of parental anxiety on comprehension of medical information within 24 hrs of a child's admission to the PICU. The physician's recognition of parental anxiety related to their child's hospitalization was also evaluated.

Design: Prospective cohort study with a convenience sample of primary caregivers of critically ill children.

Setting: Twenty-bed PICU at an urban tertiary children's hospital.

Subjects: The primary caregivers of 35 children with Pediatric Risk of Mortality III scores ≥7 admitted to the PICU as well as PICU fellows.

Interventions: Parental anxiety was assessed with the State-Trait Anxiety Inventory, a validated tool used to measure both the temporary (State) and long-standing (Trait) anxiety in adults. Comprehension of medical information was assessed by an open-ended questionnaire. Physician assessment of parental anxiety was measured by multiple-choice questionnaire.

Measurements and Main Results: Of the 34 parents completing the State-Trait Anxiety Inventory, 21 (62%) had State Anxiety that was significantly higher than a validated sample of patients with generalized anxiety disorder. The child's need for mechanical ventilation was the only significant predictor of high-parental State Anxiety (p = .03). Among the 28 parents completing the questionnaire of comprehension of medical information, 26 (93%) demonstrated excellent or fair comprehension. Physicians had generally low recognition of parental anxiety but were significantly more likely to rate a parent's anxiety as high if the child was on mechanical ventilation.

Conclusion: Parental anxiety is high following a child's admission to the PICU. Physicians failed to recognize high-parental anxiety in nearly one third of the parents. Despite the high anxiety associated with a child's admission to the PICU, parents seem to understand their children's medical issues within the first 24 hrs.

From the Department of Pediatrics, Division of Pharmacology and Critical Care, Rainbow Babies and Children's Hospital, University Hospitals/Case Medical Center, Cleveland, OH.

*See also p. 699.

Supported, in part, by Department funds, Department of Pediatrics, Division of Pharmacology and Critical Care, Rainbow Babies and Children's Hospital, Cleveland, OH.

The authors have not disclosed any potential conflicts of interest.

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©2009The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies