Psychiatric Symptoms and Acute Care Service Utilization Over the Course of the Year Following Medical-Surgical ICU Admission: A Longitudinal Investigation*
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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.Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/12000/Psychiatric_Symptoms_and_Acute_Care_Service.2.aspx
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