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

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

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.

MeSH terms

  • Aged
  • Anxiety / epidemiology*
  • Cohort Studies
  • Denmark
  • Depression / epidemiology*
  • Female
  • Humans
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Netherlands
  • Patient Discharge*
  • Risk Assessment
  • Risk Factors
  • Stress Disorders, Post-Traumatic / epidemiology*
  • Surveys and Questionnaires
  • Survivors / psychology*
  • Sweden
  • Time Factors

Associated data

  • ClinicalTrials.gov/NCT02679157