1. Psychiatric Symptoms and Acute Care Service Utilization Over the Course of the Year Following Medical-Surgical ICU Admission
- Author
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Wayne Katon, Douglas F. Zatzick, Dimitry S. Davydow, and Catherine L. Hough
- Subjects
Adult ,Male ,medicine.medical_specialty ,MEDLINE ,Critical Care and Intensive Care Medicine ,Stress Disorders, Post-Traumatic ,Risk Factors ,Service utilization ,Acute care ,medicine ,Humans ,Longitudinal Studies ,Acute stress ,Depression (differential diagnoses) ,Aged ,Academic Medical Centers ,Depressive Disorder ,Extramural ,business.industry ,Middle Aged ,medicine.disease ,Icu admission ,Hospitalization ,Intensive Care Units ,Posttraumatic stress ,Emergency medicine ,Female ,Medical emergency ,Emergency Service, Hospital ,business - Abstract
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.Longitudinal cohort study.Academic medical center.One hundred fifty patients who are 18 years old or older admitted to medical-surgical ICUs for over 24 hours.None.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.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.
- Published
- 2014