title: Employment Outcomes After Critical Illness: An Analysis of the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors Cohort.
abstract: OBJECTIVE
  To characterize survivors' employment status after critical illness and to determine if duration of delirium during hospitalization and residual cognitive function are each independently associated with decreased employment.
  
  
  METHODS
  Prospective cohort investigation with baseline and in-hospital clinical data and follow-up at 3 and 12 months.
  
  
  METHODS
  Medical and surgical ICUs at two tertiary-care hospitals.
  
  
  METHODS
  Previously employed patients from the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors study who survived a critical illness due to respiratory failure or shock were evaluated for global cognition and employment status at 3- and 12-month follow-up.
  
  
  RESULTS
  We used multivariable logistic regression to evaluate independent associations between employment at both 3 and 12 months and global cognitive function at the same time point, and delirium during the hospital stay. At 3-month follow-up, 113 of the total survival cohort of 448 (25%) were identified as being employed at study enrollment. Of these, 94 survived to 12-month follow-up. At 3- and 12-month follow-up, 62% and 49% had a decrease in employment, 57% and 49% of whom, respectively, were newly unemployed. After adjustment for physical health status, depressive symptoms, marital status, level of education, and severity of illness, we did not find significant predictors of employment status at 3 months, but better cognition at 12 months was marginally associated with lower odds of employment reduction at 12 months (odds ratio, 0.49; p = 0.07).
  
  
  CONCLUSIONS
  Reduction in employment after critical illness was present in the majority of our ICU survivors, approximately half of which was new unemployment. Cognitive function at 12 months was a predictor of subsequent employment status. Further research is needed into the potential relationship between the impact of critical illness on cognitive function and employment status.
authors.affiliation: 1Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 2Center for Health Services Research, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 3Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN. 4Department of Psychiatry, Vanderbilt Medical Center, Nashville, TN. 5Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN. 6Center for Quality of Aging, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 7Anesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN. 8Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN. 9Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Brett C
authors.initials: BC
authors.lastname: Norman
authors.forename: James C
authors.initials: JC
authors.lastname: Jackson
authors.forename: John A
authors.initials: JA
authors.lastname: Graves
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Girard
authors.forename: Pratik P
authors.initials: PP
authors.lastname: Pandharipande
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Brummel
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Thompson
authors.forename: Rameela
authors.initials: R
authors.lastname: Chandrasekhar
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
mesh_terms: D000328:Adult; D003071:Cognition; D015331:Cohort Studies; D016638:Critical Illness / Q000453:epidemiology*; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000453:epidemiology; D062707:Return to Work / Q000706:statistics & numerical data; D012770:Shock, Cardiogenic / Q000453:epidemiology; D012772:Shock, Septic / Q000453:epidemiology; D017741:Survivors; D013714:Tennessee / Q000453:epidemiology