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

Abstract

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.