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Association of Illness Severity With Family Outcomes Following Pediatric Septic Shock
Elizabeth Y Killien1,2, Jerry J Zimmerman1,3, Jane L Di Gennaro1,3
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
Insights
Family dysfunction increases after pediatric septic shock, while caregiver distress impacts child quality of life. Ongoing psychosocial support is crucial for families after critical illness.
Area of Science:
- Pediatric critical care medicine
- Psychosocial outcomes
- Family systems
Background:
- Identifying families at risk for adverse outcomes after a child's critical illness is crucial.
- Pediatric septic shock presents significant challenges for both children and their families.
Purpose of the Study:
- To assess the association between pediatric septic shock severity and caregiver distress and family dysfunction up to one year post-admission.
- To determine if caregiver outcomes correlate with child health-related quality of life (HRQL).
Main Methods:
- Secondary analysis of the Life After Pediatric Sepsis Evaluation prospective cohort study.
- Involved 276 caregivers of children (<18 years) with community-acquired septic shock requiring advanced life support.
- Utilized validated questionnaires to measure caregiver distress, family functioning, and child HRQL at multiple time points.
Main Results:
- Family dysfunction prevalence rose to 30.9% at 12 months post-admission.
- Higher illness severity scores (e.g., PELOD) were paradoxically associated with lower odds of family dysfunction.
- Caregiver distress at 1 month predicted worse child HRQL at 1, 3, and 12 months.
Conclusions:
- Family dysfunction is a growing concern in the year following pediatric septic shock.
- Caregiver psychological distress is linked to diminished child HRQL.
- Families surviving pediatric septic shock benefit from sustained psychosocial support.
Abstract:
It is unknown which families are at risk for poor outcomes following a child's critical illness.
Objectives:
To evaluate if pediatric septic shock severity is associated with caregiver distress and family dysfunction throughout the year postadmission and if caregiver outcomes are associated with child health-related quality of life (HRQL).
Design Setting And Participants:
Secondary analysis of the Life After Pediatric Sepsis Evaluation prospective cohort study among children less than 18 years old with community-acquired septic shock requiring vasoactive-inotropic support and invasive or noninvasive ventilation in 12 academic U.S. PICUs.
Main Outcomes And Measures:
Caregivers reported personal psychologic distress (Brief Symptom Inventory), family functioning (Family Assessment Device), and child HRQL (Pediatric Quality of Life Inventory, Functional Status II-Revised) at baseline and 1, 3, 6, and 12 months following PICU admission.
Results:
Among 276 caregivers, psychologic distress prevalence initially decreased then rose to 15.3%, whereas prevalence of family dysfunction increased steadily to 30.9% at 12 months. On multivariable logistic regression adjusting for patient age, medical complexity, and immunosuppression, higher Pediatric Risk of Mortality and vasoactive-inotropic scores and longer PICU and hospital stay were associated with greater caregiver distress at 1 month. Higher Pediatric Logistic Organ Dysfunction (PELOD) score, longer ventilation, and longer PICU stay were associated with lower odds of family dysfunction at 1, 3, and 6 months (average PELOD vs new 6-mo dysfunction: odds ratio [OR], 0.73 [95% CI, 0.55-0.96]). Caregiver distress was associated with child HRQL decline from baseline to 1 month (OR, 2.92 [1.27-6.75]), 3 months (OR, 2.34 [1.01-5.42]), and 12 months (OR, 3.94 [1.54-10.06]).
Conclusions And Relevance:
Family dysfunction becomes increasingly prevalent over the year following pediatric septic shock and is less likely following higher severity illness. Caregiver psychologic distress is associated with worse child HRQL. Both patients and families may benefit from ongoing psychosocial support following survival from pediatric septic shock.
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