Psychiatric symptoms and acute care service utilization over the course of the year following medical-surgical ICU admission: a longitudinal investigation*.

Abstract

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. Longitudinal cohort study. Academic medical center. One hundred fifty patients who are 18 years old or older admitted to medical-surgical ICUs for over 24 hours. None. 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. 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.