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Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission: A Systematic Review and Meta-analysis.

Publication ,  Journal Article
Ko, MSM; Poh, P-F; Heng, KYC; Sultana, R; Murphy, B; Ng, RWL; Lee, JH
Published in: Jama Pediatrics
March 2022

The pediatric intensive care unit (PICU) exposes children to stressful experiences with potential long-term psychological repercussions. However, current understanding of post-PICU psychological outcomes is incomplete.To systematically review and evaluate reported long-term psychological outcomes among children previously admitted to the PICU.A systematic search of the Cumulative Index to Nursing and Allied Health Literature, Embase, MEDLINE (PubMed), and PsycINFO was conducted from database inception to June 2021. Search terms included phrases related to intensive care (eg, intensive care units and critical care) and terms for psychological disorders (eg, posttraumatic stress disorder, depressive disorder, conduct disorder, and neurodevelopmental disorder) limited to the pediatric population.This systematic review and meta-analysis included randomized clinical trials and observational studies reporting psychological disorders among children younger than 18 years who were admitted to the PICU with follow-up for at least 3 months. Psychological disorders were defined using the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Children were excluded if they were admitted to the PICU for primary brain conditions (eg, traumatic brain injury, meningoencephalitis, and brain tumors) or discharged to the home for palliative care.Titles and abstracts were independently screened by 2 reviewers, with data extraction conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were pooled using a random-effects model during meta-analysis.Age-corrected IQ scores and long-term psychological outcomes measured by scales such as the Child Behavior Checklist (higher scores indicate more behavioral problems) among children admitted to the PICU.Of 9193 records identified, 31 independent studies (5 randomized clinical trials and 26 observational studies) involving 7786 children (mean age, 7.3 years [95% CI, 6.2-8.4 years]; 4267 boys [54.8%]; race and ethnicity were not reported by all studies) admitted to the PICU were included. Overall, 1 of 19 children (5.3%) to 14 of 16 children (88.0%) previously admitted to the PICU were reported to have at least 1 psychological disorder. Studies that examined posttraumatic stress disorder reported that 6 of 60 children (10.0%) to 31 of 102 children (30.4%) met the diagnostic criteria for the disorder at 3 to 6 months of follow-up. Compared with healthy children, those admitted to the PICU had lower IQ scores at 1 to 2 years of follow-up (mean, 89.40 points [95% CI, 88.33-90.47 points] vs 100.70 points [95% CI, 99.43-101.97 points]; P < .001) and 3 to 5 years of follow-up (mean, 88.54 points [95% CI, 83.92-93.16 points] vs 103.18 [95% CI, 100.36-105.99 points]; P < .001) and greater total emotional and behavioral problems at 4 years of follow-up (mean, 51.69 points [95% CI, 50.37-53.01 points] vs 46.66 points [95% CI, 45.20-48.13 points]; P < .001).This systematic review and meta-analysis found a high burden of psychological sequelae among children previously admitted to the PICU, suggesting that risk stratification and early interventions are needed for high-risk groups.

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Published In

Jama Pediatrics

DOI

EISSN

2168-6211

ISSN

2168-6203

Publication Date

March 2022

Volume

176

Issue

3

Start / End Page

e215767

Related Subject Headings

  • Pediatrics
  • Observational Studies as Topic
  • Mental Disorders
  • Male
  • Intensive Care Units, Pediatric
  • Humans
  • Hospitalization
  • Female
  • Child
  • 1114 Paediatrics and Reproductive Medicine
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Ko, M. S. M., Poh, P.-F., Heng, K. Y. C., Sultana, R., Murphy, B., Ng, R. W. L., & Lee, J. H. (2022). Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission: A Systematic Review and Meta-analysis. Jama Pediatrics, 176(3), e215767. https://doi.org/10.1001/jamapediatrics.2021.5767
Ko, Michelle Shi Min, Pei-Fen Poh, Katrina Yi Ching Heng, Rehena Sultana, Beverly Murphy, Regina Wan Leng Ng, and Jan Hau Lee. “Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission: A Systematic Review and Meta-analysis.Jama Pediatrics 176, no. 3 (March 2022): e215767. https://doi.org/10.1001/jamapediatrics.2021.5767.
Ko MSM, Poh P-F, Heng KYC, Sultana R, Murphy B, Ng RWL, et al. Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission: A Systematic Review and Meta-analysis. Jama Pediatrics. 2022 Mar;176(3):e215767.
Ko, Michelle Shi Min, et al. “Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission: A Systematic Review and Meta-analysis.Jama Pediatrics, vol. 176, no. 3, Mar. 2022, p. e215767. Epmc, doi:10.1001/jamapediatrics.2021.5767.
Ko MSM, Poh P-F, Heng KYC, Sultana R, Murphy B, Ng RWL, Lee JH. Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission: A Systematic Review and Meta-analysis. Jama Pediatrics. 2022 Mar;176(3):e215767.

Published In

Jama Pediatrics

DOI

EISSN

2168-6211

ISSN

2168-6203

Publication Date

March 2022

Volume

176

Issue

3

Start / End Page

e215767

Related Subject Headings

  • Pediatrics
  • Observational Studies as Topic
  • Mental Disorders
  • Male
  • Intensive Care Units, Pediatric
  • Humans
  • Hospitalization
  • Female
  • Child
  • 1114 Paediatrics and Reproductive Medicine