Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington, Seattle, WA.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
Pediatr Crit Care Med. 2023 Mar 1;24(3):222-232. doi: 10.1097/PCC.0000000000003150. Epub 2022 Dec 23.
To identify risk factors and outcomes associated with a positive post-traumatic stress disorder (PTSD) screen following pediatric acute respiratory failure treated with invasive mechanical ventilation.
Nonprespecified secondary analysis of a randomized clinical trial.
Thirty-one U.S. PICUs.
Children in the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial (NCT00814099, ClinicalTrials.gov ) over 8 years old who completed PTSD screening 6 months after discharge.
RESTORE sites were randomized to a targeted, nurse-directed sedation strategy versus usual care.
PTSD screening was completed by 102 subjects using the Child Post-Traumatic Stress Disorder Symptom Scale; a score of greater than or equal to 11 was considered screening positive for PTSD. Cognitive status was categorized using Pediatric Cerebral Performance Category; health-related quality of life (HRQL) was evaluated using child-reported Pediatric Quality of Life Inventory, Version 4.0. Thirty-one children (30%) screened positive for PTSD. Children with a positive screen endorsed symptoms in all categories: reexperiencing, avoidance, and hyperarousal. Most endorsed that symptoms interfered with schoolwork ( n = 18, 58%) and happiness ( n = 17, 55%). Screening positive was not associated with RESTORE treatment group. In a multivariable logistic model adjusting for age, sex, and treatment group, screening positive was independently associated with lower median income in the family's residential zip code (compared with income ≥ $80,000; income < $40,000 odds ratio [OR], 32.8; 95% CI, 2.3-458.1 and $40,000-$79,999 OR, 15.6; 95% CI, 1.3-182.8), renal dysfunction (OR 5.3, 95% CI 1.7-16.7), and clinically significant pain in the PICU (OR, 8.3; 95% CI, 1.9-35.7). Children with a positive screen experienced decline in cognitive function and impaired HRQL more frequently than children with a negative screen.
Screening positive for PTSD is common among children following acute respiratory failure and is associated with lower HRQL and decline in cognitive function. Routine PTSD screening may be warranted to optimize recovery.
确定与接受有创机械通气治疗的儿科急性呼吸衰竭后 PTSD 阳性筛查相关的风险因素和结果。
随机临床试验的非预设二次分析。
31 个美国 PICUs。
接受 RESTORE 试验（NCT00814099，ClinicalTrials.gov）中年龄超过 8 岁且出院后 6 个月完成 PTSD 筛查的儿童。
RESTORE 地点随机分配至目标性、护士主导的镇静策略与常规护理。
使用儿童创伤后应激障碍症状量表对 102 名受试者进行 PTSD 筛查；评分≥11 分被认为 PTSD 筛查阳性。认知状态采用小儿脑功能分类；使用儿童报告的儿科生活质量量表第四版评估健康相关生活质量。31 名儿童（30%）PTSD 筛查阳性。阳性筛查的儿童在所有类别中均出现症状：再体验、回避和警觉性增高。大多数儿童表示症状影响学业（n=18，58%）和幸福感（n=17，55%）。筛查阳性与 RESTORE 治疗组无关。在调整年龄、性别和治疗组的多变量逻辑模型中，筛查阳性与家庭居住邮政编码中家庭收入中位数较低独立相关（与收入≥$80000 相比；收入<$40000 的比值比[OR]为 32.8；95%可信区间[CI]为 2.3-458.1，收入为$40000-$79999 的 OR 为 15.6；95%CI 为 1.3-182.8），肾功能障碍（OR 5.3，95%CI 为 1.7-16.7）和 PICUs 中临床显著疼痛（OR，8.3；95%CI 为 1.9-35.7）。与阴性筛查相比，PTSD 筛查阳性的儿童认知功能下降和 HRQL 受损更为常见。
急性呼吸衰竭后儿童 PTSD 筛查阳性较为常见，与较低的 HRQL 和认知功能下降相关。常规 PTSD 筛查可能有助于优化康复。
