Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Apr 1;26(4):e516-e530.
doi: 10.1097/PCC.0000000000003701. Epub 2025 Feb 14.

The Caring Intensively Study: Three-Year Follow-Up Findings From a Mixed Methods Study of Children's Psychological and Behavioral Responses After PICU Hospitalization

Janet E Rennick  1 , Geoffrey Dougherty  2 , Karen Dryden-Palmer  3 , Marsha Campbell-Yeo  4 , Alyssa M Knox  5 , Christine T Chambers  6 , Dale M Stack  7 , Stephanie Treherne  5 , Robyn Stremler  8
Affiliations
Multicenter Study

The Caring Intensively Study: Three-Year Follow-Up Findings From a Mixed Methods Study of Children's Psychological and Behavioral Responses After PICU Hospitalization

Janet E Rennick et al. Pediatr Crit Care Med. .

Abstract

Objectives: To report the 3-year follow-up results of the "Caring Intensively" study, which examined children's psychological and behavioral responses after PICU hospitalization.

Design: Prospective mixed methods, concurrent triangulation design. In the quantitative arm, study group (SG) and comparison group (CG) children and their parents were administered a battery of measures assessing psychological and behavioral outcomes, and telephone survey data were collected 6 weeks, 6 months, 1, 2, and 3 years post-discharge. In the qualitative arm, SG interviews were conducted 1 and 3 years post-discharge. Recruitment 2014-2018, with follow-up completed 2021.

Setting: SG recruited from PICUs of three Canadian quaternary care pediatric hospitals; CG from two hospitals' ear, nose, and throat (ENT) day surgery units.

Patients: Age (3-12 yr) and gender-matched PICU children (SG, 158) or day surgery ENT children (CG, 169) and their parents were recruited; 62% of families completed the study (SG, 97; CG, 106). Selected SG families were interviewed at year 1 (17 families, 30 participants) and year 3 (14 families, 27 participants).

Interventions: None.

Measurements and main results: No group differences on primary or secondary outcomes. Both groups reported emotional and behavioral changes in children via telephone survey; however, group findings diverged on their nature and attribution. SG parents attributed changes primarily to PICU hospitalization; CG parents attributed changes to other life events. At year 3, 40.3% of SG parents still reported negative emotional and behavioral changes in children suggesting a chronic trajectory of recovery. Qualitative interview findings converged with SG survey responses, reflecting the adaptive and relational challenges confronting children and families.

Conclusions: This study highlights children's emotional and behavioral responses over the 3 years post-PICU and the need to study child recovery within the family. These findings contribute to our understanding of the nature and duration of trajectories of recovery and emphasize the importance of providing clinical follow-up and prioritizing family-identified outcomes in future research.

Keywords: longitudinal studies; outcomes; pediatric intensive care unit; pediatric medical traumatic stress; post-intensive care syndrome-pediatrics.

PubMed Disclaimer

Conflict of interest statement

Dr. Rennick was the nominated principal investigator on the Canadian Institutes of Health Research grant (MOP-123287) that supported this research. Drs. Rennick’s, Campbell-Yeo’s, Chambers’, and Stremler’s institutions received funding from the grant to support recruitment at the various sites. Dr. Rennick received a Senior Clinical Research Scholar salary award from the Fonds de Recherche du Québec—Santé during the conduct of this research. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Manning JC, Pinto NP, Rennick JE, et al. : Conceptualizing post intensive care syndrome in children—the PICS-p framework. Pediatr Crit Care Med. 2018; 19:298–300 - PubMed
    1. Watson RS, Choong K, Colville G, et al. : Life after critical illness in children—toward an understanding of pediatric post-intensive care syndrome. J Pediatr. 2018; 198:16–24 - PubMed
    1. Woodruff AG, Choong K: Long-term outcomes and the post-intensive care syndrome in critically ill children: A North American perspective. Children (Basel, Switzerland). 2021; 8:254. - PMC - PubMed
    1. Ko MSM, Poh P-F, Heng KYC, et al. : Assessment of long-term psychological outcomes after pediatric intensive care unit admission: A systematic review and meta-analysis. JAMA Pediatr. 2022; 176:e215767. - PMC - PubMed
    1. Le Brocque RM, Dow BL, McMahon H, et al. : The course of posttraumatic stress in children: Examination of symptom trajectories and predictive factors following admission to pediatric intensive care. Pediatr Crit Care Med. 2020; 21:e399–e406 - PubMed

Publication types