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Development of an ICU discharge instrument predicting psychological morbidity: a multinational study
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden.
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2018 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 44, no 12, p. 2038-2047Article in journal (Refereed) Published
Abstract [en]

Purpose: To develop an instrument for use at ICU discharge for prediction of psychological problems in ICU survivors.

Methods: Multinational, prospective cohort study in ten general ICUs in secondary and tertiary care hospitals in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay12h were eligible for inclusion. Patients in need of neurointensive care, with documented cognitive impairment, unable to communicate in the local language, without a home address or with more than one limitation of therapy were excluded. Primary outcome was psychological morbidity 3months after ICU discharge, defined as Hospital Anxiety and Depression Scale (HADS) subscale score11 or Post-traumatic Stress Symptoms Checklist-14 (PTSS-14) part B score>45.

Results: A total of 572 patients were included and 78% of patients alive at follow-up responded to questionnaires. Twenty percent were classified as having psychological problems post-ICU. Of 18 potential risk factors, four were included in the final prediction model after multivariable logistic regression analysis: symptoms of depression [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.10-1.50], traumatic memories (OR 1.44, 95% CI 1.13-1.82), lack of social support (OR 3.28, 95% CI 1.47-7.32) and age (age-dependent OR, peak risk at age 49-65years). The area under the receiver operating characteristics curve (AUC) for the instrument was 0.76 (95% CI 0.70-0.81).

Conclusions: We developed an instrument to predict individual patients' risk for psychological problems 3months post-ICU, http://www.imm.ki.se/biostatistics/calculators/psychmorb/. The instrument can be used for triage of patients for psychological ICU follow-up.

Trial registration: The study was registered at clinicaltrials.gov, NCT02679157.

Place, publisher, year, edition, pages
Springer, 2018. Vol. 44, no 12, p. 2038-2047
Keywords [en]
Intensive care, PICS, Follow-up, Depression, Post-traumatic stress, Anxiety
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:oru:diva-70858DOI: 10.1007/s00134-018-5467-3ISI: 000452162900002PubMedID: 30467678Scopus ID: 2-s2.0-85057112977OAI: oai:DiVA.org:oru-70858DiVA, id: diva2:1275918
Note

Funding Agencies:

ALF Funding  

Olle Engqvist Byggmästare Foundation 

Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved

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Savilampi, Johanna

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