• Aleksandra E Olszewski, Leslie A Dervan, Mallory B Smith, Lisa A Asaro, David Wypij, CurleyMartha A QMAQFamily and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA.Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA., and R Scott Watson.
• Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington, Seattle, WA.
• Pediatr Crit Care Me. 2023 Mar 1; 24 (3): 222232222-232.

ObjectivesTo identify risk factors and outcomes associated with a positive post-traumatic stress disorder (PTSD) screen following pediatric acute respiratory failure treated with invasive mechanical ventilation.DesignNonprespecified secondary analysis of a randomized clinical trial.SettingThirty-one U.S. PICUs.PatientsChildren in the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial (NCT00814099, ClinicalTrials.gov ) over 8 years old who completed PTSD screening 6 months after discharge.InterventionsRESTORE sites were randomized to a targeted, nurse-directed sedation strategy versus usual care.Measurements And Main ResultsPTSD screening was completed by 102 subjects using the Child Post-Traumatic Stress Disorder Symptom Scale; a score of greater than or equal to 11 was considered screening positive for PTSD. Cognitive status was categorized using Pediatric Cerebral Performance Category; health-related quality of life (HRQL) was evaluated using child-reported Pediatric Quality of Life Inventory, Version 4.0. Thirty-one children (30%) screened positive for PTSD. Children with a positive screen endorsed symptoms in all categories: reexperiencing, avoidance, and hyperarousal. Most endorsed that symptoms interfered with schoolwork ( n = 18, 58%) and happiness ( n = 17, 55%). Screening positive was not associated with RESTORE treatment group. In a multivariable logistic model adjusting for age, sex, and treatment group, screening positive was independently associated with lower median income in the family's residential zip code (compared with income ≥ $80,000; income < $40,000 odds ratio [OR], 32.8; 95% CI, 2.3-458.1 and $40,000-$79,999 OR, 15.6; 95% CI, 1.3-182.8), renal dysfunction (OR 5.3, 95% CI 1.7-16.7), and clinically significant pain in the PICU (OR, 8.3; 95% CI, 1.9-35.7). Children with a positive screen experienced decline in cognitive function and impaired HRQL more frequently than children with a negative screen.ConclusionsScreening positive for PTSD is common among children following acute respiratory failure and is associated with lower HRQL and decline in cognitive function. Routine PTSD screening may be warranted to optimize recovery.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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