Psychological consequences in pediatric intensive care unit survivors: the neglected outcome.
OBJECTIVE
To determine whether Pediatric Intensive Care Unit (PICU) hospitalization results in adverse psychological effects and to identify the contributory factors.


METHODS
Level III PICU of a tertiary center.


METHODS
Prospective cohort study.


METHODS
Consecutive patients 5 years or older admitted to PICU for at least 48 hours constituted the study population. Controls were age and sex matched children hospitalized in the pediatric wards for at least 48 hours. Severity of illness was assessed by the Pediatric Risk of Mortality (PRISM) score. Level of therapeutic intervention was determined by the Therapeutic Interventions Scoring System (TISS--76 score). Temperament Measurement Schedule was used to assess the premorbid temperament. Psychological assessment was performed using Impact of Event Scale (IES), Birleson Depression Scale and the Self-Esteem Scale. Follow-up evaluation was done one month after discharge.


RESULTS
There were 30 children each in the study and control groups. They had comparable pre-morbid temperament as well as scores on the self-esteem and depression scales. Significantly higher proportion of patients in PICU had intrusive thoughts (43%) as compared to controls (6.7%). Development of intrusive thoughts correlated significantly with the degree of intervention. Demographic parameters, nature of the disease, duration of hospitalization and severity of illness did not correlate with the psychological outcome. One month after discharge, scores in both groups were comparable.


CONCLUSIONS
Children subjected to therapeutic interventions in the PICU develop transient psychological impairment manifested by experiencing intrusive thoughts that resolve within a month.
Muranjan
Mamta N
MN
Department of Pediatrics, King Edward Memorial Hospital, Parel, Mumbai 400 012, India. muranjanmamta@rediffmail.com
Birajdar
Suresh B
SB
Shah
Henal R
HR
Sundaraman
Preeti
P
Tullu
Milind S
MS
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003141:Communicable Diseases / Q000523:psychology* / Q000534:rehabilitation*; D003865:Major Depressive Disorder / Q000209:etiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D011446:Prospective Studies; D012649:Self Concept