.jpg "Ariya Chau, MD photo")
Ariya Chau, MD
Childrens Hospital Los Angeles
Los Angeles, California
Disclosure information not submitted.
Ryan A Eckberg
Data Scientist
Children's Hospital of Los Angeles
Los Angeles, California, United States
Disclosure information not submitted.
Lili Ehrlich, PhD
Data Scientist
Children's Hospital Los Angeles
Los Angeles, California
Disclosure information not submitted.
David Ledbetter
Manager, VPICU Data Science
Children's Hospital of Los Angeles, United States
Disclosure information not submitted.
Laksana Eugene
Data Scientist
Children's Hospital of Los Angeles, United States
Disclosure information not submitted.
Melissa Aczon
Principle Data Scientist
Children's Hospital of Los Angeles, United States
Disclosure information not submitted.
Jeffrey Gold, PhD
Professor of Anesthesiology and Pediatrics
Children's Hospital of Los Angeles, United States
Disclosure information not submitted.
Randall Wetzel, BS, MB, MBA, FCCM
Professor of Anesthesiology and Pediatrics
Children's Hospital of Los Angeles
Los Angeles, California, United States
Disclosure information not submitted.
Lara Nelson, MD
Pediatric Cardiac Intensivist
Children's Hospital Los Angeles
Los Angeles, California, United States
Disclosure information not submitted.
Title: In Hospital Risk Factors to Predict Children at Risk of Posttraumatic Stress After PICU Admission
Introduction: Children admitted to the pediatric intensive care unit (PICU) have posttraumatic stress (PTS) rates up to 64%, and up to 28% of them meet diagnostic criteria for posttraumatic stress disorder (PTSD). Literature has been inconsistent in identifying factors associated with PTS. We aimed to examine the association of potentially available PICU admission elements with later PTS. Our hypothesis was patients with prior trauma history, higher heart rates (HRs), blood pressures (BPs), and extrinsic catecholamines are more likely to have later PTS.
Methods: This is a prospective, observational study of children admitted to the PICU at a quaternary hospital. Children aged 8-17 years old without developmental delay, severe psychiatric disorder, or traumatic brain injury were included. Children’s pre-hospitalization trauma history was assessed with a semi-structured interview. All in-hospital variables were from the electronic medical record. The outcome variable of PTS was defined as being present if children had four of the DSM-IV criteria for PTSD. Student’s t- and chi-squared tests were used to compare presence or absence of prior trauma, HR (1st recorded value; mean; max; average from 1st 20 minutes of admission), systolic BP (max; mean), mean arterial BP, max inotrope score, pain, chronic illness, PICU admission type, benzodiazepine and opioid use.
Results: Of the 110 patients at baseline, 68 had 3-month follow-up. In the latter group, 46% met criteria for PTS, mean age 13 years (SD 3), 57% male, mean PRISM III score 4.9 (SD 4.3), and ICU length of stay 6.5 days (SD 7.8). There were no statistically significant differences in the demographics of the patients with and without PTS. The only variable to show significance was trauma history; patients with pre-hospitalization trauma were more likely to have PTS at 3 month follow-up (p= 0.02).
Conclusions: In this cohort, prior trauma history was the only predictor of children at risk for developing PTS after admission to the PICU despite an extensive exploration of in-hospital potential risk factors, including signs of increased physiologic stress response. Previous studies have focused on these predictors, but this study suggests future studies should shift to the potential predictive benefit of screening children for trauma history upon PICU admission.