P0066 / #1083: DECLINE IN HEALTH-RELATED QUALITY OF LIFE AMONG CRITICALLY ILL PEDIATRIC PATIENTS EXPERIENCING UNCONTROLLED PAIN

Abstract

Aims & Objectives: Among pediatric burn patients, in-hospital pain is associated with mental health comorbidities post-discharge. This relationship for the general PICU population is unknown. We evaluated the association between uncontrolled pain and decline in health-related quality of life (HRQL) following critical illness. Methods: We conducted a retrospective cohort study of patients admitted to the Seattle Children’s Hospital PICU from 2011-2017. HRQL was assessed with the Pediatric Qaulity of Life Inventory (PedsQL)or Functional Status Scale (FS) II-R (for children with developmental disabilities) at baseline and post-discharge (median 6 weeks). Associations between any days of uncontrolled pain [≥1 day with nursing documented pain score >4 (e.g. moderate or worse pain) for at least 25% of the day] and decline in HRQL (>4.5 points) were estimated using logistic regression adjusted for age, PRISM, PCPC, and PICU LOS. We also identified specific HRQL questions with the highest frequency of decline. Results: Patients with uncontrolled pain (n=219, 50%) were younger (mean 4.1 vs 7.6 years, p<0.001) and had longer hospital LOS (mean 8.1 vs 4.8 days, p<0.001), and greater benzodiazepine exposure (mean 10.1 vs 7.0 mg lorazepam equivalents, p<0.001). Patients with uncontrolled pain were more likely to have a decline in HRQL [29% vs 22%, aRR=1.5 (95% CI, 1.1-2.2), p=0.02]. Children with uncontrolled pain experienced more post-discharge sleep difficulties and worrying on the PedsQL and more tiredness, crying, and difficulty occupying themselves on the FS-IIR.Conclusions: Critically ill children who experience uncontrolled pain have a decline in their HRQL post-discharge. The relationship between pain and long-term psychosocial dysfunction requires further investigation.