Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden.
Crit Care. 2017 Nov 9;21(1):273. doi: 10.1186/s13054-017-1813-z.
BACKGROUND: A majority of patients survive their episode of critical illness but up to 30% of patients suffer from psychological problems such as post-traumatic stress, anxiety and depression in the year after intensive care unit (ICU) stay. A method to identify discharged patients at risk for adverse psychological outcome would be helpful in the triage for ICU follow-up and could enable early intervention. The aim of this study was to evaluate whether early screening with validated questionnaires after ICU discharge can identify patients at risk for symptoms of post-traumatic stress, anxiety and depression 3 months after ICU stay. METHODS: We performed a prospective observational cohort study in the general ICU at the Karolinska University Hospital Solna, Stockholm, Sweden. All adult patients surviving ≥ 24 hours in the ICU in a 9-month period were eligible for inclusion. Patients with mental disability, serious auditory and visual disorder, aphasia or who were unable to understand Swedish were excluded. One hundred and thirty-two patients were included and visited by a follow-up nurse within 1 week after ICU discharge. The Hospital Anxiety and Depression Scale (HADS) and the Post-Traumatic Stress Symptoms Checklist-10 (PTSS-10) were administered. Three months after ICU discharge the patients received the same questionnaires by postal mail. We assessed the predictive values of the questionnaires using the area under the receiver operating characteristic curve (AUROC). For correlation calculations, we used Spearman's rank correlation coefficient. Negative and positive predictive values for each questionnaire were calculated. RESULTS: Eighty-two patients returned the follow-up questionnaires. We found correlation between early and late scores and reasonable predictive precision regarding 3-month outcomes, with an AUROC of 0.90 for PTSS-10 part B, 0.80 for the HADS anxiety subscale and 0.75 for the HADS depression subscale. CONCLUSIONS: Symptoms of post-traumatic stress, anxiety and depression assessed 1 week after ICU stay correlate with 3-month psychological outcome. The HADS and PTSS-10 may be useful aids to identify ICU survivors at high risk for clinically significant symptoms of post-traumatic stress, anxiety and depression 3 months post ICU stay.
背景:大多数危重病患者都能存活下来,但多达 30%的患者在重症监护病房(ICU)入住后一年内会出现创伤后应激、焦虑和抑郁等心理问题。一种识别出院后患者发生不良心理结局风险的方法将有助于 ICU 随访的分诊,并能实现早期干预。本研究旨在评估 ICU 出院后使用经过验证的问卷进行早期筛查是否能识别出 3 个月后 ICU 住院期间出现创伤后应激、焦虑和抑郁症状的高危患者。
方法:我们在瑞典斯德哥尔摩卡罗林斯卡大学医院索尔纳的普通 ICU 进行了一项前瞻性观察队列研究。在 9 个月期间,存活时间超过 24 小时的所有成年 ICU 患者都有资格入选。排除有精神残疾、严重视听障碍、失语症或无法理解瑞典语的患者。共纳入 132 名患者,在 ICU 出院后 1 周内由随访护士进行访视。采用医院焦虑抑郁量表(HADS)和创伤后应激症状清单-10 项(PTSS-10)进行评估。3 个月后,患者通过邮寄收到相同的问卷。我们使用受试者工作特征曲线下面积(AUROC)评估问卷的预测值。对于相关性计算,我们使用斯皮尔曼等级相关系数。计算了每个问卷的阴性和阳性预测值。
结果:82 名患者返回了随访问卷。我们发现早期和晚期评分之间存在相关性,且对于 3 个月的结局具有合理的预测精度,PTSS-10 部分 B 的 AUROC 为 0.90,HADS 焦虑分量表为 0.80,HADS 抑郁分量表为 0.75。
结论:ICU 入住后 1 周评估的创伤后应激、焦虑和抑郁症状与 3 个月的心理结局相关。HADS 和 PTSS-10 可能有助于识别 ICU 幸存者在 ICU 入住 3 个月后出现创伤后应激、焦虑和抑郁等临床显著症状的高风险。
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