Post-traumatic stress after PICU and corticosteroid use

Burcher, Georgina Corbet; Picouto, María Dolores; Als, Lorraine C; Cooper, Marie; Pierce, Christine; Nadel, Simon

doi:10.1136/archdischild-2017-314157

Cited by 7 publications

(5 citation statements)

References 4 publications

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“…This may re ect a possible underlying sensitivity of the cerebral regions connected to memory-based PTSD symptoms to acute rises in in ammatory mediators (22). Furthermore, in contrast to our previous ndings [10], we did not observe an association between corticosteroid use and reduced PTSD symptoms. It is possible that any early protective effects of steroid use also recede over time.…”

Section: Discussioncontrasting

confidence: 99%

“…In addition to these sociodemographic and environmental factors, it is possible that clinical and biological factors related to the acute illness may be signi cant in the development of PTSD in young people following a critical-illness related trauma. Longer length of PICU stay [1,7], and greater illness severity [8,9] have been suggested to be associated with later development of PTSD symptoms; and one study supports corticosteroids having a short-term protective effect [10]. In adult survivors of critical illness, the use of benzodiazepines and presentation of delirium are the strongest predictive factors for later development of PTSD symptoms [11], but it is unknown if this is also the case in paediatric populations.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for PTSD symptoms following PICU admission for childhood septic shock

Burcher,

Lancaster,

McCutcheon

et al. 2024

Preprint

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Objective Paediatric intensive care unit (PICU) admission represents a traumatic event for many children. Follow-up studies have found post-traumatic stress disorder (PTSD) rates of 10-30%, with a particular prevalence following admission for sepsis. Dysregulated inflammatory responses are associated with PTSD. Sepsis involves a marked inflammatory response but the relationship between this and PTSD have not been clearly established. In this study we investigate associations between the inflammatory response, psychosocial risk factors, and PTSD symptoms following PICU admission for septic shock. Setting Children aged >3 years, discharged from PICU following admission for septic shock between 2010 and 2017. Design The study was a retrospective analysis of PICU-specific PTSD symptoms reported by parents at any time since discharge via the Trauma and Behavior health screen. Demographics, pre-morbid health characteristics, and exposure to other traumatic events were assessed. Clinical characteristics and blood test results at admission and at 48 hours were recorded from clinical records. Multiple linear regression was used to investigate relationships between PTSD symptom scores and predictor variables. Results Data for 65 participants (48% male, median assessment age 8.0 years) was available. Median time since admission was 5.1 years. 30.8% children scored at risk of PTSD at any time since discharge. Symptoms were significantly associated with acute CRP rise (p=0.03), other trauma exposures (p=0.01), and female gender (p=0.04). Conclusion PTSD symptoms in children who have survived septic shock are prevalent. These findings support a possible contribution of acute inflammatory changes, cumulative traumatic exposure, and female gender in post-PICU PTSD development.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk factors for PTSD symptoms following PICU admission for childhood septic shock

Burcher,

Lancaster,

McCutcheon

et al. 2024

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…must be couched however, that this finding was detected on post-hoc analysis. Furthermore, in contrast to our previous findings [11], we did not observe an association between corticosteroid use and reduced PTS symptoms. It is possible that any early protective effects of steroid use also recede over time.…”

Section: Discussioncontrasting

confidence: 99%

“…In addition to these sociodemographic and environmental factors, it is possible that clinical and biological factors related to the acute illness may be significant in the development of PTSD in young people following a critical-illness related trauma. Longer length of PICU stay [1,7], greater illness severity [8,9] and use of midazolam [10] have been suggested to be associated with later development of PTS symptoms; and one study supports corticosteroids having a short-term protective effect [11]. In adult survivors of critical illness, the use of benzodiazepines and presentation of delirium are the strongest predictive factors for later development of PTS symptoms [12], but it is unknown if this is also the case in paediatric populations.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for PTSD symptoms following PICU admission for childhood septic shock

Corbet Burcher,

O’Dea,

Cooper

et al. 2024

Eur Child Adolesc Psychiatry

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ObjectivePaediatric intensive care unit (PICU) admission represents a traumatic event for many children. Follow-up studies have found post-traumatic stress disorder (PTSD) rates of 10–30%, with a particular prevalence following admission for sepsis. Dysregulated inflammatory responses are associated with PTSD. Sepsis involves a marked inflammatory response but the relationship between this and PTSD have not been clearly established. In this study we investigate associations between the inflammatory response, psychosocial risk factors, and PTS symptoms following PICU admission for septic shock.We investigate the outcomes for children aged > 3 years, discharged from one PICU following admission for septic shock between 2010 and 2017. The study was a retrospective analysis of PICU-specific PTS symptoms reported by parents at any time since discharge via the Trauma and Behavior Health screen. Demographics, pre-morbid health characteristics, and exposure to other traumatic events were assessed. Clinical characteristics and blood test results at admission and at 48 h were recorded from clinical records. Multiple linear regression was used to investigate relationships between PTS symptom scores and predictor variables.Data for 65 participants (48% male, median assessment age 8.0 years) was available. Median time since admission was 5.1 years. 30.8% children scored at risk of PTSD at any time since discharge Symptoms were significantly associated with acute CRP rise (p 0.03), other trauma exposures (p = 0.01), and female gender (p =0.04).PTS symptoms in children who have survived septic shock are prevalent. These findings support a possible contribution of acute inflammatory changes, cumulative traumatic exposure, and female gender in post-PICU PTSD development.

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“…Acutely, it is possible that focus towards reduction in systemic inflammation through use of anti-inflammatory medications may potentially reduce the development of psychiatric sequelae. 29 30 To our knowledge, this hypothesis has not been tested observationally or experimentally in paediatric settings. Furthermore, it is possible that these findings may have prognostic value for certain children following discharge from PICU.…”

Section: Discussionmentioning

confidence: 97%

Inflammation and psychopathology in children following PICU admission: an exploratory study

Caspani

Burcher

Cooper

et al. 2018

Evid Based Mental Health

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BackgroundSurvivors of critical illness in childhood commonly display subsequent psychiatric symptoms including emotional and behavioural difficulties, and manifestations of post-traumatic stress disorder (PTSD). Anomalies in inflammatory profiles are an established finding in these childhood psychiatric conditions.ObjectiveThis exploratory study aimed to investigate whether abnormal peripheral blood inflammatory markers measured during paediatric intensive care unit (PICU) admission were associated with psychiatric symptoms after discharge.MethodsWe performed a prospective observational cohort study on 71 children with septic illness, meningoencephalitis and other critical disorders admitted to two PICUs between 2007 and 2010. 3–6 months following discharge, subjects were assessed for global psychiatric risk (ie, presence of emotional and behavioural difficulties on the parental Strengths and Difficulties Questionnaire (SDQ)), and for PTSD risk using the child-rated Impact of Events Scale (IES-8). Inflammatory and related biological markers were transcribed from PICU admission notes (white cell count, lymphocytes, neutrophils, C reactive protein (CRP), platelets, fibrinogen and lactate).FindingsGlobal psychiatric risk at follow-up was associated with abnormal lymphocyte count during admission (χ2=6.757, p=0.014, n=48). In children with sepsis, partial correlation analyses controlling for age and gender highlighted associations between (i) SDQ scores and low lymphocyte count (r=−0.712; p=0.009, n=14), and (ii) IES-8 score and high CRP levels (r=0.823; p=0.006, n=11). These associations remained after correction for multiple comparisons.ConclusionThese results support the hypothesis that acute inflammation may play a role in determining the development of psychopathology following PICU admission.Clinical implicationsIf the findings are replicated, they may help to better highlight which children are at risk of post-PICU psychopathology and appropriately target follow-up.

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Post-traumatic stress after PICU and corticosteroid use

Abstract: Corticosteroid use may be associated with fewer PTSD symptoms and lower evening cortisol levels following PICU admission in children with sepsis.

Cited by 7 publications

References 4 publications

Risk factors for PTSD symptoms following PICU admission for childhood septic shock

Risk factors for PTSD symptoms following PICU admission for childhood septic shock

Risk factors for PTSD symptoms following PICU admission for childhood septic shock

Inflammation and psychopathology in children following PICU admission: an exploratory study

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