Association of Illness Severity With Family Outcomes Following Pediatric Septic Shock

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.

Keywords: caregivers; health-related quality of life; intensive care units; pediatric; psychologic distress; septic; shock.

Figure 1.

Flow diagram of participants included in Life After Pediatric Sepsis Evaluation (LAPSE) with follow-up data. BSI = brief symptom inventory, FAD = family assessment device, HRQL = health-related quality of life.

Figure 2.

Prevalence of decline in proxy-reported health-related quality of life (HRQL) from baseline (≥4.5 points) by presence or absence of caregiver distress (Brief Symptom Inventory [BSI]) and family dysfunction (Family Assessment Device [FAD]), with odds ratios for HRQL decline with a positive relative to a negative BSI or FAD.