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Behavioral changes in pediatric intensive care units
S M Jones1, D H Fiser, R L Livingston
1Department of Pediatrics, Arkansas Children's Hospital, Little Rock 72202-3591.
Insights
Critically ill children in intensive care units (ICUs) and those with prior mental health conditions show higher risks for psychological distress and behavioral issues. The Hospital Observed Behavior Scale reliably quantifies these behaviors in hospitalized children.
Area of Science:
- Pediatric Psychology
- Child Psychiatry
- Critical Care Medicine
Background:
- Hospitalized children, particularly those in intensive care, may experience significant psychological distress.
- Understanding the frequency and severity of anxiety, depression, delirium, and withdrawal is crucial for effective intervention.
- Preexisting mental health conditions can influence the manifestation of these symptoms in pediatric patients.
Purpose of the Study:
- To compare the incidence and severity of psychological symptoms (anxiety, depression, delirium, withdrawal) in pediatric patients between intensive care unit (ICU) and ward settings.
- To assess the impact of pre-existing psychopathological disorders on the expression of these symptoms.
- To validate the Hospital Observed Behavior Scale (HOBS) as a reliable tool for quantifying behavioral manifestations in hospitalized children.
Main Methods:
- Prospective study of 43 pediatric patients (ages 6-17) in a tertiary care center.
- Patients were divided into intensive care unit (n=18) and general ward (n=25) groups.
- The Hospital Observed Behavior Scale (HOBS) was used for objective behavioral assessment, alongside the Diagnostic Interview for Children and Adolescents (DICA) and its parent version to identify pre-existing disorders.
Main Results:
- Pediatric patients in the ICU exhibited higher rates of apprehension, anxiety, detachment, sadness, and weeping compared to ward patients, as measured by HOBS.
- Behavioral manifestations were significantly influenced by illness severity, hospitalization duration, prior hospitalizations, and pre-existing anxiety or mood disorders.
- The Hospital Observed Behavior Scale demonstrated good interrater reliability.
Conclusions:
- Critically ill children in ICUs, those with prolonged or repeated hospitalizations, and those with pre-existing anxiety and mood disorders are at elevated risk for psychological trauma and behavioral problems.
- These at-risk pediatric populations may require psychiatric intervention.
- The Hospital Observed Behavior Scale is a reliable instrument for quantifying behavioral symptoms in hospitalized children.
Objective:
The purposes of this study were to compare the frequency and severity of manifestations of anxiety, depression, delirium, and withdrawal in pediatric patients hospitalized in intensive care unit vs ward settings and to evaluate the impact of preexisting psychopathologic disorders on the expression of these symptoms.
Research Design:
Prospective patient series.
Setting:
Tertiary care pediatric center.
Patients:
Forty-three subjects aged 6 to 17 years hospitalized in either the pediatric or cardiovascular intensive care unit (n = 18) or on the general wards (n = 25) were recruited to participate. Subjects were excluded if their parents were unavailable for diagnostic interview or if they could not answer interview questions themselves.
Selection Procedures:
Consecutive sample.
Interventions:
None.
Measurements And Results:
The Hospital Observed Behavior Scale, developed for this study, was used to describe objectively subjects' manifestations of anxiety, depression, delirium, and withdrawal. The Diagnostic Interview for Children and Adolescents and Diagnostic Interview for Children and Adolescents-Parents were used to determine the presence of preexisting psychopathologic disorders. As measured by the Hospital Observed Behavior Scale, subjects in the intensive care unit exhibited apprehension, anxiety, detachment, sadness, and weeping more often than did patients in the ward. Behavior was also significantly influenced by severity of illness, duration of hospitalization, number of previous hospitalizations, and presence of a preexisting anxiety or mood disorder. We found the Hospital Observed Behavior Scale to have good interrater reliability.
Conclusions:
Our data indicate that critically ill children in the intensive care unit, children with prolonged or repeated hospitalizations, and children with preexisting anxiety and mood disorders are at greater risk than other hospitalized pediatric patients for psychological trauma and/or behavior problems that may warrant psychiatric intervention. The Hospital Observed Behavior Scale is a reliable tool to quantitate behaviors in hospitalized children.