Cognitive/affective factors are associated with children's acute posttraumatic stress following pediatric intensive care.

This study aimed to explore children's experiences and memories of the pediatric intensive care unit (PICU) and identify the relative importance of premorbid, trauma, and cognitive/affective variables associated with acute posttraumatic stress symptoms (PTSS). Participants were 95 children aged 6-16 years admitted to the PICU and their parents. Children completed questionnaires and an interview assessing PTSS, peritrauma affect, and their memory of the admission 3 weeks following discharge. Medical data were extracted from patient charts. Premorbid and demographic data were provided by parent questionnaire. Most children remembered some aspects of their admission. Younger age, admission for traumatic injury (rather than non-injury-related reasons), and cognitive/affective factors including confusion, peritrauma panic, and sensory memory quality were associated with acute PTSS. Age and traumatic injury accounted for 18% of the variance in PTSS (p < .01). The addition of cognitive/affective variables increased the explained variance to 38% (p < .001). Child age did not moderate the effect of cognitive/affective variables on PTSS. This study demonstrates that objective indicators of disease severity do not adequately explain the high prevalence of PTSS in children following PICU admission. It also suggests that subjective, cognitive factors such as the way children process and remember a PICU admission are very important in the onset of PTSS. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

'True Blood' The Critical Care Story: An audit of blood sampling practice across three adult, paediatric and neonatal intensive care settings.

BACKGROUND: Anaemia is common in critically ill patients, and has a significant negative impact on patients' recovery. Blood conservation strategies have been developed to reduce the incidence of iatrogenic anaemic caused by sampling for diagnostic testing. OBJECTIVES: Describe practice and local guidelines in adult, paediatric and neonatal Australian intensive care units (ICUs) regarding blood sampling and conservation strategies. METHODS: Cross-sectional descriptive study, conducted July 2013 over one week in single adult, paediatric and neonatal ICUs in Brisbane. Data were collected on diagnostic blood samples obtained during the study period, including demographic and acuity data of patients. Institutional blood conservation practice and guidelines were compared against seven evidence-based recommendations. RESULTS: A total of 940 blood sampling episodes from 96 patients were examined across three sites. Arterial blood gas was the predominant reason for blood sampling in each unit, accounting for 82% of adult, 80% of paediatric and 47% of neonatal samples taken (p<0.001). Adult patients had significantly more median [IQR] samples per day in comparison to paediatrics and neonates (adults 5.0 [2.4]; paediatrics 2.3 [2.9]; neonatal 0.7 [2.7]), which significantly increased median [IQR] blood sampling costs per day (adults AUD$101.11 [54.71]; paediatrics AUD$41.55 [56.74]; neonatal AUD$8.13 [14.95]; p<0.001). The total volume of samples per day (median [IQR]) was also highest in adults (adults 22.3mL [16.8]; paediatrics 5.0mL [1.0]; neonates 0.16mL [0.4]). There was little information about blood conservation strategies in the local clinical practice guidelines, with the adult and neonatal sites including none of the seven recommendations. CONCLUSIONS: There was significant variation in blood sampling practice and conservation strategies between critical care settings. This has implications not only for anaemia but also infection control and healthcare costs.

The diagnosis of posttraumatic stress disorder in school-aged children and adolescents following pediatric intensive care unit admission.

OBJECTIVES: This study explored the diagnosis of posttraumatic stress disorder (PTSD) in children and adolescents following pediatric intensive care unit (PICU) admission. Specifically, the study aimed to describe the presentation and prevalence of PTSD symptoms 6 months postdischarge, explore the validity of the DSM-IV PTSD algorithm and alternative PTSD algorithm (PTSD-AA) in school-aged children and adolescents, and examine the diagnostic utility of Criterion C3 (inability to recall aspects of a trauma) in this cohort. METHODS: Participants were 59 children aged 6-16, admitted to PICU for at least 8 hours. PTSD was assessed via diagnostic interview (Children's PTSD Inventory) 6 months following PICU discharge. RESULTS: The PTSD-AA was found to provide the most valid measure of PTSD at 6 months. Removing Criterion C3 improved the validity of Criterion C. CONCLUSIONS: This study supports the use of the PTSD-AA excluding Criterion C3 for identifying highly traumatized children and adolescents following PICU admission.

The utility of the Children's Revised Impact of Event Scale in screening for concurrent PTSD following admission to intensive care.

Although there is some information available regarding the utility of the Children's Revised Impact of Event Scale (CRIES) in screening for posttraumatic stress disorder (PTSD), data are scarce and limited to studies sampling children predominantly injured in road traffic accidents. This study investigated the utility of 2 versions, the CRIES-8 and CRIES-13, in identifying those children meeting criteria for PTSD following admission to a pediatric intensive care unit (PICU). The Children's PTSD Inventory (CPTSDI), a diagnostic interview, and the CRIES-13 were administered to 55 children, aged 6-16 years, 6 months following admission to the PICU. Of the 55, 14 (25%) met criteria on the CPTSDI. Cutoff scores of 14.5 on the CRIES-8 and 22.5 on the CRIES-13 maximized sensitivity and specificity and correctly classified 78%-86% of children. Both cutoff scores were lower than those reported in other samples. The CRIES-13 appeared to offer greater utility than the CRIES-8, also in contrast to previous findings. Methodological or sampling differences may account for the discrepancy with prior studies. The proposed cutoffs are recommended specifically for use with PICU patients and replication and further validation of the CRIES with other samples is warranted.