MANIFESTATIONS OF THE ICU SYNDROME IN CHILDREN

Abstract

The ICU Syndrome, manifested by anxiety, depression, hallucinations, and delirium, has been reported to occur in children but has not been well documented. The purpose of this study was to determine factors associated with the development of ICU Syndrome in children. Forty-three children between the ages of 6 and 17 years were studied, 18 in ICU and 25 on general wards. The Hospital Observed Behavior Scale (HOBS) was developed to describe acute adverse psychological reactions in four areas: anxiety, depression, delirium, and withdrawal. The Diagnostic Interview for Children and Adolescents (DICA) was administered to each subject and the DICA-P to each subject's parent to elicit any pre-existing psychopathology. Additional data collected included demographics, diagnosis, prognosis, previous admissions, duration of parental visitation (PV), amount of sleep, and medications. Good interrater reliability was found for the HOBS (r=0,63, p< 0.000001). Sixteen subjects demonstrated behavior clinically consistent with the ICU Syndrome, 11 ICU and 5 ward subjects. The mean HOBS scores were statistically different for those with and without the ICU Syndrome (9.3 ± 4.1 vs. 3.9 ± 3.6; p< 0.0005). Factors positively correlated with the mean HOBS were pre-existing anxiety disorder and race (black); negatively correlated was PV (p < 0.10). We conclude that the ICU Syndrome may be reliably diagnosed using HOBS and that it may occur in patients in both ICU and ward settings.