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. 2014 Dec;42(12):2473-81.
doi: 10.1097/CCM.0000000000000527.

Psychiatric symptoms and acute care service utilization over the course of the year following medical-surgical ICU admission: a longitudinal investigation*

Dimitry S Davydow  1 , Catherine L Hough, Douglas Zatzick, Wayne J Katon
Affiliations

Psychiatric symptoms and acute care service utilization over the course of the year following medical-surgical ICU admission: a longitudinal investigation*

Dimitry S Davydow et al. Crit Care Med. 2014 Dec.

Abstract

Objective: To determine if the presence of in-hospital substantial acute stress symptoms, as well as substantial depressive or posttraumatic stress disorder symptoms at 3 months post-ICU, are associated with increased acute care service utilization over the course of the year following medical-surgical ICU admission.

Design: Longitudinal cohort study.

Setting: Academic medical center.

Patients: One hundred fifty patients who are 18 years old or older admitted to medical-surgical ICUs for over 24 hours.

Interventions: None.

Measurements and main results: Participants were interviewed in-hospital to ascertain substantial acute stress symptoms using the Posttraumatic Stress Disorder Checklist-Civilian version. Substantial depressive and posttraumatic stress disorder symptoms were assessed using the Patient Health Questionnaire-9 and the Posttraumatic Stress Disorder Checklist-Civilian version, respectively, at 3 months post-ICU. The number of rehospitalizations and emergency department visits were ascertained at 3 and 12 months post-ICU using the Cornell Services Index. After adjusting for participant and clinical characteristics, in-hospital substantial acute stress symptoms were independently associated with greater risk of an additional hospitalization (relative risk, 3.00; 95% CI, 1.80-4.99) over the year post-ICU. Substantial posttraumatic stress disorder symptoms at 3 months post-ICU were independently associated with greater risk of an additional emergency department visit during the subsequent 9 months (relative risk, 2.29; 95% CI, 1.09-4.84) even after adjusting for both rehospitalizations and emergency department visits between the index hospitalization and 3 months post-ICU.

Conclusions: Post-ICU psychiatric morbidity is associated with increased acute care service utilization during the year after a medical-surgical ICU admission. Early interventions for at-risk ICU survivors may improve long-term outcomes and reduce subsequent acute care utilization.

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Conflict of interest statement

Disclosures: Drs. Davydow, Hough, and Zatzick have no relevant conflicts of interest to disclose. Dr. Katon discloses that he has received honoraria in the last 12 months for CME lectures funded indirectly by Lilly, Forest and Pfizer.

Dr. Davydow has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Figures

Figure
Figure
Study Flow Diagram Abbreviations (in alphabetical order): ER = emergency room; HMC = Harborview Medical Center; ICU = intensive care unit.
See this image and copyright information in PMC

Comment in

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