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Developing the Children's Critical Illness Impact Scale: capturing stories from children, parents, and staff
Janet E Rennick1, Linda F McHarg, Melissa Dell'Api
1Department of Nursing Research, the Montreal Children's Hospital of the McGill University Health Centre, School of Nursing, McGill University, Montreal, Quebec, Canada H3H 1P3. janet.rennick@muhc.mcgill.ca
Insights
A new scale, the Children's Critical Illness Impact Scale (CCIIS), was developed to measure psychological distress in school-aged children after pediatric intensive care. This validated tool helps identify children needing support to promote healthy development.
Area of Science:
- Pediatric Critical Care Medicine
- Child Psychology
- Health Outcomes Research
Background:
- Pediatric critical care necessitates addressing psychological distress in children post-intensive care.
- Existing measures for psychological outcomes in these children are limited.
- Ethical considerations require validated tools to assess post-hospitalization psychological sequelae.
Purpose of the Study:
- To develop and validate the Children's Critical Illness Impact Scale (CCIIS).
- To create a reliable measure for posthospitalization psychological distress in children aged 6-12 years.
- To provide a tool for assessing the impact of pediatric intensive care unit (PICU) hospitalization.
Main Methods:
- A two-phase measurement development study: item generation and scale formatting, followed by item reduction and revisions.
- Qualitative data from focus groups and interviews with children, parents, and healthcare professionals informed item generation.
- Content validity was assessed by children and healthcare professionals, with a content validity index of 0.87.
Main Results:
- Five key domains identified: worries, fears, friends and family, sense of self, and behaviors.
- The final Children's Critical Illness Impact Scale (CCIIS) comprises 23 items.
- The scale demonstrated good content validity, interpretability, and usability, with older children preferring written items and younger children potentially benefiting from a pictorial version.
Conclusions:
- The Children's Critical Illness Impact Scale (CCIIS) is a novel, content-valid self-report measure for school-aged children post-PICU.
- The CCIIS is specifically relevant for assessing psychological distress in this population.
- Accessible and developmentally appropriate measures like the CCIIS are crucial for identifying at-risk children and supporting their healthy growth and development.
Objective:
With the evolution of pediatric critical care medicine has come an awareness of the ethical imperative of healthcare professionals to attend to the psychological sequelae of technologically intensive care. Recent attempts to measure psychological outcomes in these children have been limited. The purpose of this study was to develop a measure of posthospitalization distress, the Children's Critical Illness Impact Scale (CCIIS), for children aged 6-12 yrs following pediatric intensive care unit hospitalization.
Design:
A measurement development study consisting of two phases: 1) item generation and scale formatting; and 2) item reduction and scale revisions. Items were generated following thematic analysis of qualitative data from focus groups and individual interviews with children, parents, and healthcare professionals. Children reviewed items for interpretability and importance and assessed scaling technique and item presentation; healthcare professionals further evaluated item relevance.
Setting:
The pediatric intensive care units of three quaternary care, Canadian pediatric teaching hospitals.
Patients:
Phase 1 included 18 children, 22 parents, and 12 healthcare professionals (n = 52). Phase 2 included eight children and four healthcare professionals (n = 12).
Measurements And Main Results:
Five key domains were identified in the thematic analyses: worries, fears, friends and family, sense of self, and behaviors. Thirty-six items were initially generated, and subsequent item reduction resulted in 23 items that were retained on the final scale. Items were generally rated extremely relevant and were judged to capture the content area (content validity index = 0.87). The CCIIS was easily understood, and the scaling format worked well. Older children preferred written items, while younger children will require a modified, pictorial version.
Conclusions:
The CCIIS is a new self-report measure with demonstrated content validity and specific relevance for young school-aged children following pediatric intensive care unit hospitalization. Valid, accessible, and developmentally appropriate measures are essential to identify high-risk children and, ultimately, promote healthy growth and development.
