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Midazolam exposure in the paediatric intensive care unit predicts acute post-traumatic stress symptoms in children
Debbie Long1, Kristen Gibbons2, Robyne Le Brocque3
1Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Australia; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Australia.
Insights
Post-traumatic stress symptoms (PTSS) affect 24% of pediatric intensive care unit (PICU) survivors. Midazolam use was linked to PTSS one month after discharge, highlighting potential treatment factors for pediatric critical care.
Area of Science:
- Pediatric critical care medicine
- Pediatric psychology
- Trauma recovery
Background:
- Post-traumatic stress symptoms (PTSS) affect up to 25% of pediatric intensive care unit (PICU) survivors, impacting recovery.
- Limited data exist on modifiable PICU treatment factors, like analgosedatives, associated with pediatric PTSS.
Purpose of the Study:
- To investigate medical treatment factors associated with PTSS in children after PICU discharge.
- To identify potential interventions for mitigating PTSS in pediatric critical care survivors.
Main Methods:
- Prospective longitudinal cohort study in two Australian PICUs.
- Inclusion of children aged 2-16 years admitted for >8 hours and <28 days.
- Data collection from medical records and parent-reported PTSS via the Trauma Symptom Checklist for Young Children for 12 months post-discharge.
- Logistic regression analysis to assess associations between medical treatment and PTSS.
Main Results:
- 24% of children experienced clinically elevated PTSS within 12 months post-PICU discharge.
- Higher risk of death score (PIM2) was associated with PTSS.
- Intubation, PICU/hospital length of stay, midazolam, propofol, and morphine were linked to PTSS at 1 month.
- Midazolam was the only factor independently associated with PTSS at 1 month (aOR 3.63, p=0.024) after controlling for confounders.
Conclusions:
- Elevated PTSS were observed in 24% of children during the year following PICU discharge.
- Midazolam therapy was significantly associated with increased likelihood of PTSS one month after PICU discharge.
- No significant medication-related PTSS associations were found beyond one month post-discharge.
Background:
Clinically significant post-traumatic stress symptoms (PTSS) have been reported in up to a quarter of paediatric intensive care unit (PICU) survivors. Ongoing PTSS negatively impacts children's psychological development and physical recovery. However, few data regarding associations between potentially modifiable PICU treatment factors, such as analgosedatives and invasive procedures, and children's PTSS have been reported.
Objectives:
We sought to investigate the medical treatment factors associated with children's PTSS after PICU discharge.
Methods:
A prospective longitudinal cohort study was conducted in two Australian tertiary referral PICUs. Children aged 2-16 y admitted to the PICU between June 2008 and January 2011 for >8 h and <28 d were eligible for participation. Biometric and clinical data were obtained from medical records. Parents reported their child's PTSS using the Trauma Symptom Checklist for Young Children at 1, 3, 6, and 12 months after discharge. Logistic regression was used to assess potential associations between medical treatment and PTSS.
Results:
A total of 265 children and their parents participated in the study. In the 12-month period following PICU discharge, 24% of children exhibited clinically elevated PTSS. Median risk of death (Paediatric Index of Mortality 2 [PIM2]) score was significantly higher in the PTSS group (0.31 [IQR 0.14-1.09] v 0.67 [IQR 0.20-1.18]; p = 0.014). Intubation and PICU and hospital length of stay were also significantly associated with PTSS at 1 month, as were midazolam, propofol, and morphine. After controlling for gender, reason for admission, and PIM2 score, only midazolam was significantly and independently associated with PTSS and only at 1 month (adjusted odds ration (aOR) 3.63, 95% CI 1.18, 11.12, p = 0.024). No significant relationship was observed between the use of medications and PTSS after 1 month.
Conclusions:
Elevated PTSS were evident in one quarter (24%) of children during the 12 months after PICU discharge. One month after discharge, elevated PTSS were most likely to occur in children who had received midazolam therapy.
