Elizabeth Killien, MD, MPH
Assistant Professor
Seattle Children's Hospital
Seattle, Washington
Disclosure information not submitted.
.jpg "Jerry Zimmerman, MD, PhD, FCCM photo")
Jerry Zimmerman, MD, PhD, FCCM
Faculty, Pediatric Critical Care Medicine
Seattle Children's Hospital
Seattle, Washington
Disclosure information not submitted.
J. Lin Di Gennaro, MD, MS
Associate Professor
Seattle Children's Hospital, United States
Disclosure information not submitted.
R Watson, MD, MPH
Professor, Pediatrics
University of Washington & Seattle Children's Hospital, United States
Disclosure information not submitted.
Title: Association of Illness Severity with Family Outcomes Following Pediatric Septic Shock
Introduction:
Illness severity is strongly associated with poor child health-related quality of life (HRQL) following pediatric septic shock, but how a child’s illness severity impacts family outcomes is unknown. We evaluated whether pediatric septic shock severity was associated with caregiver distress and family dysfunction over the year post-admission and if caregiver outcomes were associated with child HRQL.
Methods:
We conducted a secondary analysis of the Life After Pediatric Sepsis Evaluation prospective cohort study that enrolled children < 18 years in 12 US PICUs with septic shock requiring vasoactive and respiratory support. Caregivers reported child HRQL (Pediatric Quality of Life Inventory or Functional Status II-R) and their own psychological distress (Brief Symptom Inventory, BSI) and family functioning (Family Assessment Device, FAD) at baseline (pre-admission recall) and 1, 3, 6, and 12 months post-admission. We estimated associations between illness severity, family outcomes, and child HRQL using multivariable logistic regression adjusted for patient age, medical complexity, and immunosuppression.
Results:
Among 276 caregivers, the percentage with psychologic distress (BSI ≥20) initially decreased then rose to 15.3% at 12 months, while family dysfunction (FAD ≥2) increased through 12 months to 30.9%. Higher Pediatric Risk of Mortality and vasoactive-inotropic scores and longer PICU and hospital stay were associated with psychological distress at 1 month. Higher Pediatric Logistic Organ Dysfunction (PELOD) score and longer ventilation and PICU stay were associated with lower odds of new family dysfunction at 1, 3, and 6 months (average PELOD vs new 6-month dysfunction: OR 0.73, 95% CI 0.55-0.96). Caregiver psychological distress was associated with child HRQL decline from baseline to 1 month (OR 2.92, 1.27-6.75), 3 months (OR 2.34, 1.01-5.42), and 12 months (OR 3.94, 1.54-10.06).
Conclusions:
Family dysfunction becomes increasingly prevalent over the year following pediatric septic shock, but higher illness severity is somewhat protective. Caregiver psychological distress is associated with illness severity only at 1 month post-admission and is associated with worse child HRQL. Both patients and families may benefit from ongoing psychosocial support following survival from pediatric septic shock.