Longitudinal Trajectories of Caregiver Distress and Family Functioning After Community-Acquired Pediatric Septic Shock,Pediatric Critical Care Medicine

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Longitudinal Trajectories of Caregiver Distress and Family Functioning After Community-Acquired Pediatric Septic Shock
Pediatric Critical Care Medicine ( IF 4.1 ) Pub Date : 2020-09-01 , DOI: 10.1097/pcc.0000000000002404
Lexa K. Murphy ₁ , Tonya M. Palermo _{1,

2} , Kathleen L. Meert ₃ , Ron Reeder ₄ , J. Michael Dean ₄ , Russell Banks ₄ , Robert A. Berg ₅ , Joseph A. Carcillo ₆ , Ranjit Chima ₇ , Julie McGalliard ₈ , Wren Haaland ₈ , Richard Holubkov ₄ , Peter M. Mourani ₉ , Murray M. Pollack ₁₀ , Anil Sapru ₁₁ , Samuel Sorenson ₄ , James W. Varni ₁₂ , Jerry Zimmerman ₈

Affiliation

Center for Child Health Behavior and Development, Seattle Children’s Research Institute, Seattle, WA.
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit, MI.
Department of Pediatrics, University of Utah, Salt Lake City, UT.
Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA.
Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, OH.
Department of Pediatrics, Seattle Children’s Hospital, Seattle Research Institute, University of Washington School of Medicine, Seattle, WA.
Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital of Colorado, Aurora, CO.
Department of Pediatrics, Children’s National Health System, Washington, DC.
Department of Pediatrics, Mattel Children’s Hospital, University of California Los Angeles, Los Angeles, CA.
Department of Pediatrics, Texas A&M University, College Station, TX.

Objectives:

To identify trajectories and correlates of caregiver distress and family functioning in families of children who survived community-acquired septic shock. We hypothesized that: 1) a substantial subset of families would demonstrate trajectories of persistent elevated caregiver distress and impaired family functioning 12 months after hospitalization and 2) sociodemographic and clinical risk factors would be associated with trajectories of persistent distress and family dysfunction.

Design:

Prospective cohort.

Setting:

Fourteen PICUs in the United States.

Patients:

Caregivers of 260 children who survived community-acquired septic shock.

Interventions:

None.

Measurements and Main Results:

Caregivers completed ratings of distress on the Brief Symptom Inventory and of family functioning on the Family Assessment Device at baseline, 1, 3, 6, and 12 months after hospitalization. Results from group-based trajectory modeling indicated that 67% of the current sample was characterized by persistent low caregiver distress, 26% by persistent moderate to high distress that remained stable across 12 months (high-risk caregiver distress group), and 8% by initial high distress followed by gradual recovery. Forty percent of the sample was characterized by stable high family functioning, 15% by persistent high dysfunction across 12 months (high-risk family functioning group), 12% by gradually improving functioning, and 32% by deteriorating function over time. Independently of age, child race was associated with membership in the high-risk caregiver distress group (non-white/Hispanic; effect size, –0.12; p = 0.010). There were no significant sociodemographic or clinical correlates of the high-risk family functioning group in multivariable analyses.

Conclusions:

Although the majority of families whose children survived community-acquired septic shock were characterized by resilience, a subgroup demonstrated trajectories of persistently elevated distress and family dysfunction during the 12 months after hospitalization. Results suggest a need for family-based psychosocial screening after pediatric septic shock to identify and support at-risk families.

中文翻译：

社区获得性小儿败血性休克后照顾者痛苦和家庭功能的纵向轨迹

目标：

为了确定在社区获得性败血性休克中幸存下来的儿童家庭的照顾者苦恼和家庭功能的轨迹和相关性。我们假设：1）住院后12个月，大部分家庭会表现出持续的照料者困扰和家庭功能受损的轨迹，并且2）社会人口统计学和临床风险因素与持续困扰和家庭功能障碍的轨迹有关。

设计：

预期队列。

设置：

美国有14个PICU。

耐心：

260名在社区获得性败血性休克中存活的儿童的保姆。

干预措施：

没有。

测量和主要结果：

护理人员在基线后，住院后1、3、6和12个月完成了简短症状清单上的苦恼评估和家庭评估装置上的家庭功能评估。基于组的轨迹模型的结果表明，当前样本中67％的特征为持续的低照料者困扰，26％的持续中度至高困扰，在12个月内保持稳定（高风险照料者困扰组），8％为最初的高困扰，然后逐渐恢复。40％的样品具有稳定的高家族功能，在12个月内持续存在的高机能障碍占15％（高危家庭功能组），逐渐改善功能的占12％，随着时间的推移功能恶化而占32％。与年龄无关，儿童种族与高风险看护者困扰组的成员相关（非白人/西班牙裔；影响量，–0.12；p = 0.010）。在多变量分析中，高危家庭功能组没有明显的社会人口统计学或临床相关性。