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Mental and Physical Well-Being Following Admission to Pediatric Intensive Care

Als, Lorraine C. PhD1; Picouto, Maria D. PhD, LMS2; Hau, Sau-Ming BSc1; Nadel, Simon FRCP3; Cooper, Mehrengise FRCPCH, FFICM3; Pierce, Christine M. FRCPCH4; Kramer, Tami MBBCh, MRCPsych1; Garralda, M. Elena MD, FRCPsych, FRCPCH1

Pediatric Critical Care Medicine: June 2015 - Volume 16 - Issue 5 - p e141–e149
doi: 10.1097/PCC.0000000000000424
Online Clinical Investigations

Objective: To assess mental and physical well-being in school-aged children following admission to pediatric intensive care and to examine risk factors for worse outcome.

Design: A prospective cohort study.

Setting: Two PICUs.

Subjects: A consecutive sample of 88 patients 5–16 years old (median age, 10.00 yr; interquartile range, 6.00–13.00 yr) admitted to PICU from 2007 to 2010 with septic illness, meningoencephalitis, or other critical illnesses were assessed a median of 5 months following discharge and outcomes compared with 100 healthy controls.

Interventions: None.

Measurements and Main Results: Parents completed questionnaires documenting child mental and physical well-being, including the Strengths and Difficulties Questionnaires, Chalder Fatigue Scale, and Child Sleep Habits Questionnaire. Children over 8 years completed the Impact of Event Scale -8. The children admitted to PICU scored worse on all measures in comparison with the healthy controls, with 20% scoring at risk for psychiatric disorder, 34% with high levels of post-traumatic stress symptoms, 38% at risk for fatigue disorder, and 80% scoring at risk for sleep disturbance. In the PICU group, multivariable regression analyses identified septic illness as an independent predictor of post-traumatic stress symptoms and family status, past child health problems, and PICU length of stay as predictors of reduced general mental well-being.

Conclusions: Our findings indicate that a significant minority of school-aged children admitted to PICU are at risk for reduced mental and physical well-being in the short term. Symptoms of poor mental well-being were linked to both vulnerability factors and critical illness factors.

1Centre for Mental Health, Department of Medicine, Imperial College London, London, United Kingdom.

2Department of Child and Adolescent Psychiatry and Psychology, Sant Joan de Déu Hospital, Universitat de Barcelona, Barcelona, Spain.

3Department of Paediatric Intensive Care, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.

4Department of Paediatric Intensive Care, Great Ormond Street Hospital, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.

The work was carried out at Imperial College Academic Health Science Centre and Great Ormond Street Hospital for Children.

Supported, in part, by the Meningitis Research Foundation of the United Kingdom. The funder had no role in the study design, execution, analysis, or article preparation. This research was undertaken at the Imperial College Academic Health Science Centre and Great Ormond Street Hospital for Children NHS Trust, both of which are supported by the National Institute for Health Research (NIHR) Biomedical Research Centres funding scheme. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

Dr. Als received support for travel from the Rebecca Harwood Memorial Fund (COSMIC) and from the Imperial College Hallinan Travel Fund. She is employed by the Children of St Mary's Intensive Care (COSMIC) charity. Her institution received grant support from the Meningitis Research Foundation. Dr. Picouto was supported by funding from the Alicia Koplowitz Foundation; served as a board member for the Alicia Koplowitz Foundation (assessment for applications for research grants 2013); is employed by Hospital Maternoinfantil Sant Joan de Deu; and lectured for the CONFIAS Foundation. Her institution received grant support from the Meningitis Research Foundation (MRF) and the Alicia Koplowitz Foundation and received support for travel from the Alicia Koplowitz Foundation. Dr. Hau’s institution received grant support from the Meningitis Research Foundation (MRF). Dr. Nadel lectured and consulted for Novartis Vaccines. His institution received grant support from the Meningitis Research Foundation and COSMIC. Dr. Cooper’s institution received grant support from Meningitis Research Foundation and COSMIC. Dr. Pierce consulted for Actelion and is employed by the Great Ormond Street Hospital NHS trust. Her institution received grant support from Pfizer and Actelion and lectured for Actelion. Dr. Kramer is employed by the Imperial College London and the CNWL NHS Foundation Trust; her institution received grant support from the MRF and from the NIHR (research grant). Dr. Garralda’s institution received grant support from the Meningitis Research Foundation and COSMIC.

For information regarding this article, E-mail: l.als@imperial.ac.uk

©2015The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies