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Strengths and Difficulties Questionnaire Assessment of Long-Term Psychological Outcome in Children After Intensive Care Admission*

Kyösti, Elina MD1,2; Ala-Kokko, Tero I. MD, PhD1,2; Ohtonen, Pasi MSci1,2; Peltoniemi, Outi MD, PhD3,4; Ebeling, Hanna MD, PhD4,5; Spalding, Michael MD, PhD1,2; Rautiainen, Paula MD, PhD6; Kataja, Janne MD, PhD7; Liisanantti, Janne H. MD, PhD1,2

Pediatric Critical Care Medicine: November 2019 - Volume 20 - Issue 11 - p e496-e502
doi: 10.1097/PCC.0000000000002078
Online Clinical Investigations

Objectives: We investigated the long-term psychologic symptoms of patients who survived pediatric intensive care admission.

Design: Longitudinal follow-up study.

Setting: Nationwide cohort study based on a national ICU register and a questionnaire survey.

Patients: All pediatric patients (0–16 yr old) who were admitted to an ICU in Finland in 2009–2010.

Interventions: None.

Measurements and Main Results: Six years after ICU admission, all surviving patients were sent the Strengths and Difficulties Questionnaire, and questionnaires regarding chronic diseases and need for medication and therapy. At the end of the follow-up period, there were 3,674 surviving children who had been admitted to an ICU in 2009–2010. Of these children, 1,105 completed the Strengths and Difficulties Questionnaire 6 years after admission. Strengths and Difficulties Questionnaire scores were abnormal for 84 children (7.6%), borderline for 80 (7.2%), and normal for 941 (85.2%). Participants with abnormal scores were younger at admission to the ICU (3.06 vs 4.70 yr; p = 0.02), and more commonly had a chronic disease (79.5% vs 47.4%; p < 0.001), a need for continuous medication (49.4% vs 31.7%; p < 0.001), a need for therapy (58.5% vs 15.9%; p < 0.001), and a need for annual healthcare visits (91.4% vs 85.2%; p = 0.05). Abnormal Strengths and Difficulties Questionnaire scores were associated with higher rates of neurologic (32.1% vs 10.2%), gastrointestinal (7.1% vs 3.9%), psychiatric (3.6% vs 0.5%), and chromosomal disorders (9.5% vs 1.3%), as well as with long-term pain (1.2% vs 0.6%).

Conclusions: Participants with abnormal Strengths and Difficulties Questionnaire scores (poor psychologic outcome) at 6 years after childhood ICU admission more commonly suffered neurologic, chromosomal, or psychiatric diagnoses or long-term pain, and generally required higher levels of healthcare services, therapies, and medication.

1Medical Research Centre of Oulu University and Oulu University Hospital, Oulu, Finland.

2Research Group of Surgery, Anaesthesiology and Intensive Care Medicine, Oulu Finland.

3Division of Intensive Care Medicine, Department of Paediatrics, Oulu University Hospital, Oulu, Finland.

4PEDEGO Research Unit, University of Oulu, Oulu, Finland.

5Clinic of Child Psychiatry, Oulu University Hospital, Oulu, Finland.

6Department of Anaesthesia and Intensive Care, Children´s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

7Department of Paediatrics, Turku University Hospital, Turku, Finland.

*See also p. 1099.

Dr. Kyösti received support for article research from Alma and K. A. Snellman Foundation Finnish grant for Pediatric Research. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies