Abstract
Objective: To assess intensive care unit (ICU)/acute care service-delivery characteristics and pre-ICU factors as predictors of posttraumatic stress disorder (PTSD) and return to usual major activity after ICU admission for trauma. Method: Data from the National Study on the Costs and Outcomes of Trauma were used to evaluate a prospective cohort of 1906 ICU survivors. We assessed PTSD with the PTSD Checklist. Regression analyses ascertained associations between ICU/acute care service-delivery characteristics, pre-ICU factors, early post-ICU distress and 12-month PTSD and return to usual activity, while controlling for clinical and demographic characteristics. Results: Approximately 25% of ICU survivors had symptoms suggestive of PTSD. Increased early post-ICU distress predicted both PTSD and diminished usual major activity. Pulmonary artery catheter insertion [risk ratio (RR) 1.28, 95% confidence interval (95% CI) 1.05-1.57, P=.01] and pre-ICU depression (RR 1.23, 95% CI 1.02-1.49, P=.03) were associated with PTSD. Longer ICU lengths of stay (RR 1.21, 95% CI 1.03-1.44, P=.02) and tracheostomy (RR 1.29, 95% CI 1.05-1.59, P=.01) were associated with diminished usual activity. Greater preexisting medical comorbidities were associated with PTSD and limited return to usual activity. Conclusions: Easily identifiable risk factors including ICU/acute care service-delivery characteristics and early post-ICU distress were associated with increased risk of PTSD and limitations in return to usual major activity. Future investigations could develop early screening interventions in acute care settings targeting these risk factors, facilitating appropriate treatments.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 428-435 |
| Number of pages | 8 |
| Journal | General Hospital Psychiatry |
| Volume | 31 |
| Issue number | 5 |
| DOIs | |
| State | Published - Sep 2009 |
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Keywords
- Critical care
- Intensive care unit
- Outcome assessment (health care)
- Risk factors
- Stress disorder, Posttraumatic
ASJC Scopus subject areas
- Psychiatry and Mental health
Cite this
Predictors of posttraumatic stress disorder and return to usual major activity in traumatically injured intensive care unit survivors. / Davydow, Dimitry S.; Zatzick, Douglas F.; Rivara, Frederick P.; Jurkovich, Gregory J.; Wang, Jin; Roy-Byrne, Peter P.; Katon, Wayne J.; Hough, Catherine L.; Kross, Erin K.; Fan, Ming Yu; Joesch, Jutta; Mackenzie, Ellen J.
In: General Hospital Psychiatry, Vol. 31, No. 5, 09.2009, p. 428-435.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Predictors of posttraumatic stress disorder and return to usual major activity in traumatically injured intensive care unit survivors
AU - Davydow, Dimitry S.
AU - Zatzick, Douglas F.
AU - Rivara, Frederick P.
AU - Jurkovich, Gregory J.
AU - Wang, Jin
AU - Roy-Byrne, Peter P.
AU - Katon, Wayne J.
AU - Hough, Catherine L.
AU - Kross, Erin K.
AU - Fan, Ming Yu
AU - Joesch, Jutta
AU - Mackenzie, Ellen J
PY - 2009/9
Y1 - 2009/9
N2 - Objective: To assess intensive care unit (ICU)/acute care service-delivery characteristics and pre-ICU factors as predictors of posttraumatic stress disorder (PTSD) and return to usual major activity after ICU admission for trauma. Method: Data from the National Study on the Costs and Outcomes of Trauma were used to evaluate a prospective cohort of 1906 ICU survivors. We assessed PTSD with the PTSD Checklist. Regression analyses ascertained associations between ICU/acute care service-delivery characteristics, pre-ICU factors, early post-ICU distress and 12-month PTSD and return to usual activity, while controlling for clinical and demographic characteristics. Results: Approximately 25% of ICU survivors had symptoms suggestive of PTSD. Increased early post-ICU distress predicted both PTSD and diminished usual major activity. Pulmonary artery catheter insertion [risk ratio (RR) 1.28, 95% confidence interval (95% CI) 1.05-1.57, P=.01] and pre-ICU depression (RR 1.23, 95% CI 1.02-1.49, P=.03) were associated with PTSD. Longer ICU lengths of stay (RR 1.21, 95% CI 1.03-1.44, P=.02) and tracheostomy (RR 1.29, 95% CI 1.05-1.59, P=.01) were associated with diminished usual activity. Greater preexisting medical comorbidities were associated with PTSD and limited return to usual activity. Conclusions: Easily identifiable risk factors including ICU/acute care service-delivery characteristics and early post-ICU distress were associated with increased risk of PTSD and limitations in return to usual major activity. Future investigations could develop early screening interventions in acute care settings targeting these risk factors, facilitating appropriate treatments.
AB - Objective: To assess intensive care unit (ICU)/acute care service-delivery characteristics and pre-ICU factors as predictors of posttraumatic stress disorder (PTSD) and return to usual major activity after ICU admission for trauma. Method: Data from the National Study on the Costs and Outcomes of Trauma were used to evaluate a prospective cohort of 1906 ICU survivors. We assessed PTSD with the PTSD Checklist. Regression analyses ascertained associations between ICU/acute care service-delivery characteristics, pre-ICU factors, early post-ICU distress and 12-month PTSD and return to usual activity, while controlling for clinical and demographic characteristics. Results: Approximately 25% of ICU survivors had symptoms suggestive of PTSD. Increased early post-ICU distress predicted both PTSD and diminished usual major activity. Pulmonary artery catheter insertion [risk ratio (RR) 1.28, 95% confidence interval (95% CI) 1.05-1.57, P=.01] and pre-ICU depression (RR 1.23, 95% CI 1.02-1.49, P=.03) were associated with PTSD. Longer ICU lengths of stay (RR 1.21, 95% CI 1.03-1.44, P=.02) and tracheostomy (RR 1.29, 95% CI 1.05-1.59, P=.01) were associated with diminished usual activity. Greater preexisting medical comorbidities were associated with PTSD and limited return to usual activity. Conclusions: Easily identifiable risk factors including ICU/acute care service-delivery characteristics and early post-ICU distress were associated with increased risk of PTSD and limitations in return to usual major activity. Future investigations could develop early screening interventions in acute care settings targeting these risk factors, facilitating appropriate treatments.
KW - Critical care
KW - Intensive care unit
KW - Outcome assessment (health care)
KW - Risk factors
KW - Stress disorder, Posttraumatic
UR - http://www.scopus.com/inward/record.url?scp=68949150802&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=68949150802&partnerID=8YFLogxK
U2 - 10.1016/j.genhosppsych.2009.05.007
DO - 10.1016/j.genhosppsych.2009.05.007
M3 - Article
C2 - 19703636
AN - SCOPUS:68949150802
VL - 31
SP - 428
EP - 435
JO - General Hospital Psychiatry
JF - General Hospital Psychiatry
SN - 0163-8343
IS - 5
ER -