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Intensive Care Med. 2018 Dec;44(12):2038-2047. doi: 10.1007/s00134-018-5467-3. Epub 2018 Nov 22.

Development of an ICU discharge instrument predicting psychological morbidity: a multinational study.

Author information

1
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. anna.milton@sll.se.
2
Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden. anna.milton@sll.se.
3
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
4
Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
5
Department of Anaesthesiology and Intensive Care, Sodersjukhuset, Stockholm, Sweden.
6
Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
7
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
8
Department of Surgery and Perioperative Science, Umeå University, Umeå, Sweden.
9
Department of Anaesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden.
10
Department of Intensive Care, Rigshospitalet Copenhagen, Copenhagen, Denmark.
11
Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
12
Department of Intensive Care, Odense University Hospital, Odense, Denmark.
13
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
14
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.

Abstract

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 stay ≥ 12 h 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 3 months after ICU discharge, defined as Hospital Anxiety and Depression Scale (HADS) subscale score ≥ 11 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 49-65 years). 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 3 months 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.

KEYWORDS:

Anxiety; Depression; Follow-up; Intensive care; PICS; Post-traumatic stress

PMID:
30467678
DOI:
10.1007/s00134-018-5467-3

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