Abstract
Background
Evidence suggests that intensive care unit (ICU) survivors often suffer long-term
complications such as post–intensive care syndrome (PICS) and post-traumatic stress
disorder (PTSD) from critical illness and ICU stay. PICS and PTSD affect both ICU
survivors and their families, which overburdens the healthcare systems. Lack of evidence
on the comparative psychometric properties of assessment tools is a major barrier
in evidence-based screening for post-ICU symptomatology and health-related quality
of life.
Objectives
We aimed to identify existing tools for screening PTSD and PICS in ICU survivors and
their families and to examine evidence on the validity, reliability, sensitivity,
and specificity of existing tools, as reflected in published peer-reviewed studies.
Method
A scoping review based on literature searches (CINAHL, MEDLINE, EMBASE, PsycINFO,
Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and
Google Scholar) and predefined eligibility criteria was conducted according to current
scoping review guidelines.
Findings
We identified 44 studies reporting on the development and assessment of psychometric
properties of PICS/PTSD in ICU survivors or families globally. We identified five
tools addressing all three aspects of PICS manifestations, one tool for both physical
and mental aspects of PICS, and fivefive tools for quality-of-life assessment in ICU
survivors. Altogether, 25 tools assess only one aspect of PICS: five for cognitive
impairment, seven for physical impairment, and 13 for mental health impairment and
PTSD in ICU survivors. However, only two tools were found for PICS-family assessment.
Other findings include (i) unclear validity and often limited feasibility of tools,
(ii) low diagnostic accuracy of cognitive assessment tools, and (iii) evidence of
appropriate psychometric properties and feasibility of psychological health assessment
tools.
Conclusion
These results have implications for the selection and implementation of the assessment
methods as a means for promoting meaningful patient-centred clinical outcomes to minimise
long-term sequelae, reduce the rate of rehospitalisation, and optimise recovery after
ICU discharge.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Australian Critical CareAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Co-occurrence of post-intensive care syndrome problems among 406 survivors of critical illness.Crit Care Med. 2018; 46: 1393-1401https://doi.org/10.1097/CCM.0000000000003218
- Long-term complications of critical care.Crit Care Med. 2011; 39: 371-379https://doi.org/10.1097/CCM.0b013e3181fd66e5
- Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference.Crit Care Med. 2012; 40: 502-509https://doi.org/10.1097/CCM.0b013e318232da75
- Quality of life after intensive care: a systematic review of the literature.Crit Care Med. 2010; 38: 2386-2400https://doi.org/10.1097/CCM.0b013e3181f3dec5
- Post-intensive care syndrome: an overview.Journal of Translational Internal Medicine. 2017; 5: 90-92https://doi.org/10.1515/jtim-2016-0016
- Long-term outcomes after critical illness: recent insights.Crit Care. 2021; 25: 108https://doi.org/10.1186/s13054-021-03535-3
- Post-intensive care syndrome: a concept analysis.Int J Nurs Stud. 2021; 114103814https://doi.org/10.1016/j.ijnurstu.2020.103814
- Posttraumatic stress disorder in critical illness survivors: a metaanalysis.Crit Care Med. 2015; 43: 1121-1129https://doi.org/10.1097/CCM.0000000000000882
- Depressive symptoms after critical illness: a systematic review and meta-analysis.Crit Care Med. 2016; 44: 1744-1753
- Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis.Crit Care. 2019; 23: 213https://doi.org/10.1186/s13054-019-2489-3
- Family response to critical illness: postintensive care syndrome-family.Crit Care Med. 2012; 40: 618-624https://doi.org/10.1097/CCM.0b013e318236ebf9
- Emotional experiences and coping strategies of family members of critically ill patients.Chest. 2020; 158: 1464-1472https://doi.org/10.1016/j.chest.2020.05.535
- Psychological reactions in family members of patients hospitalised in intensive care units.Anaesthesiol Intensive Ther. 2014; 46: 42-45https://doi.org/10.5603/AIT.2014.0009
- Potentially modifiable risk factors for long-term cognitive impairment after critical illness: a systematic review.Mayo Clin Proc. 2018; 93: 68-82
- The incidence of intensive care unit-acquired weakness syndromes: a systematic review.Journal of the Intensive Care Society. 2015; 16: 126-136https://doi.org/10.1177/1751143714563016
- Non-pharmacological interventions to reduce ICU-related psychological distress: a systematic review.Minerva Anestesiol. 2016; 82: 465-478
- Critical care follow-up clinics: a scoping review of interventions and outcomes.Clinical Nurse Specialist CNS. 2016; 30: 227-237https://doi.org/10.1097/NUR.0000000000000219
- The effect of ICU diaries on psychological outcomes and quality of life of survivors of critical illness and their relatives: a systematic review and meta-analysis.Crit Care Med. 2019; 47: 273-279https://doi.org/10.1097/CCM.0000000000003547
- Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults.2017 (Retrieved from)
- What is the best core measure after critical illness when the IES-R is no longer accessible for new researchers?.Crit Care. 2019; 23: 313https://doi.org/10.1186/s13054-019-2595-2
- Scoping studies: advancing the methodology.Implement Sci: IS. 2010; 5: 69https://doi.org/10.1186/1748-5908-5-69
- PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation.Ann Intern Med. 2018; 169: 467-473https://doi.org/10.7326/M18-0850
- The development of a quality appraisal tool for studies of diagnostic reliability (QAREL).J Clin Epidemiol. 2010; 63: 854-861https://doi.org/10.1016/j.jclinepi.2009.10.002
- Fatigue in chronically critically ill patients following intensive care - reliability and validity of the multidimensional fatigue inventory (MFI-20).Health Qual Life Outcome. 2018; 16: 37https://doi.org/10.1186/s12955-018-0862-6
- Post-traumatic stress disorder after weaning from prolonged mechanical ventilation.Intensive Care Med. 2010; 36: 2030-2037https://doi.org/10.1007/s00134-010-1972-8
- Long-term health-related quality of life and burden of disease after intensive care: development of a patient-reported outcome measure.Crit Care. 2021; 25: 82https://doi.org/10.1186/s13054-021-03496-7
- Validation of a new clinical tool for post-intensive care syndrome.Am J Crit Care: an official publication, American Association of Critical-Care Nurses. 2019; 28: 10-18https://doi.org/10.4037/ajcc2019639
- Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings - results of an expert consensus and feasibility field test.Journal of the Intensive Care Society. 2021; 22: 159-174https://doi.org/10.1177/1751143720923597
Jeong, Y. J., & Kang, J. (n.d.). Development and validation of a questionnaire to measure post-intensive care syndrome. Intensive Crit Care Nurs, 55. https://doi/10.1016/j.iccn.2019.102756.
- Cut-off values of the post-intensive care syndrome questionnaire for the screening of unplanned hospital readmission within one year.Journal of Korean Academy of Nursing. 2020; 50: 787-798https://doi.org/10.4040/jkan.20233
- Developing and evaluating an instrument to measure Recovery after INtensive care: the RAIN instrument.BMC Nurs. 2018; 17: 5https://doi.org/10.1186/s12912-018-0275-1
- Development of the 3-SET 4P questionnaire for evaluating former ICU patients' physical and psychosocial problems over time: a pilot study.Intensive Crit Care Nurs. 2009; 25: 80-89https://doi.org/10.1016/j.iccn.2008.06.004
- Psychometric evaluation of 3-set 4P questionnaire.Intensive Crit Care Nurs. 2013; 29: 40-47https://doi.org/10.1016/j.iccn.2012.06.002
- Short Form 36 in the intensive care unit: assessment of acceptability, reliability and validity of the questionnaire.Anaesthesia. 1997; 52: 15-23
- Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life.Crit Care Med. 2000; 28: 3599-3605https://doi.org/10.1097/00003246-200011000-00006
- Quality of life after intensive care with the sickness impact profile.Intensive Care Med. 1995; 21: 422-428https://doi.org/10.1007/bf01707411
- Quality of life following intensive care.J Gen Intern Med. 1988; 3: 218-223https://doi.org/10.1007/BF02596335
- Performance of two measures of general health-related quality of life, the EQ-5D and the RAND-36 among critically ill patients.Intensive Care Med. 2004; 30: 2245-2252https://doi.org/10.1007/s00134-004-2471-6
- Measuring quality of life after intensive care using the Arabic version for Morocco of the EuroQol 5 Dimensions.BMC Res Notes. 2012; 5: 56https://doi.org/10.1186/1756-0500-5-56
- Measurement properties of the short form 36 and health-related quality of life after intensive care in Morocco.Acta Anaesthesiol Scand. 2007; 51: 189-197https://doi.org/10.1111/j.1399-6576.2006.01225.x
- Development and validation of an abbreviated questionnaire to easily measure cognitive failure in ICU survivors: a multicenter study.Crit Care Med. 2018; 46: 79-84https://doi.org/10.1097/CCM.0000000000002806
- Cognitive screening among acute respiratory failure survivors: a cross-sectional evaluation of the Mini-Mental State Examination.Crit Care. 2015; 19: 220https://doi.org/10.1186/s13054-015-0934-5
- Preliminary validation of the montreal cognitive assessment tool among sepsis survivors: a prospective pilot study.Annals of the American Thoracic Society. 2018; 15: 1108-1110https://doi.org/10.1513/AnnalsATS.201804-233OC
Baumbach, P., Götz, T., Meissner, W., Guenther, A., & Witte, O. W. . (n.d.). Perceived cognitive impairments after critical illness: a longitudinal study in survivors and family member controls. Acta Anaesthesiol Scand, 60(8), 1121–1130. https://doi/10.1111/aas.12755.
- Formation and validation of a telephone battery to assess cognitive function in acute respiratory distress syndrome survivors.J Crit Care. 2006; 21: 125-132https://doi.org/10.1016/j.jcrc.2005.11.004
- ICU discharge screening for prediction of new-onset physical disability-A multinational cohort study.Acta Anaesthesiol Scand. 2020; 64: 789-797https://doi.org/10.1111/aas.13563
- Early prediction of new-onset physical disability after intensive care unit stay: a preliminary instrument.Crit Care. 2014; 18: 455https://doi.org/10.1186/s13054-014-0455-7
- Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness.Crit Care. 2014; 18: R55https://doi.org/10.1186/cc13801
- The Chelsea critical care physical assessment tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study.Physiotherapy. 2013; 99: 33-41https://doi.org/10.1016/j.physio.2012.01.003
- Assessing functional status after intensive care unit stay: the Barthel Index and the Katz Index.Int J Qual Health Care : journal of the International Society for Quality in Health Care. 2018; 30: 265-270https://doi.org/10.1093/intqhc/mzx203
- Construct validity and minimal important difference of 6-minute walk distance in survivors of acute respiratory failure.Chest. 2015; 147: 1316-1326https://doi.org/10.1378/chest.14-1808
- Psychological assessment of ICU survivors: a comparison between the hospital anxiety and depression scale and the depression, anxiety and stress scale.Anaesthesia. 2007; 62: 239-243https://doi.org/10.1111/j.1365-2044.2006.04948.x
- Psychometric evaluation of the hospital anxiety and depression scale 3 months after acute lung injury.J Crit Care. 2015; 30: 793-798https://doi.org/10.1016/j.jcrc.2015.04.006
- Early psychological screening of intensive care unit survivors: a prospective cohort study.Crit Care. 2017; 21: 273https://doi.org/10.1186/s13054-017-1813-z
- Development of an ICU discharge instrument predicting psychological morbidity: a multinational study.Intensive Care Med. 2018; 44: 2038-2047https://doi.org/10.1007/s00134-018-5467-3
- Developing an early screening instrument for predicting psychological morbidity after critical illness.Crit Care. 2013; 17: R210https://doi.org/10.1186/cc13018
Nickel, M., Nickel, C., Mitterlehner, F., Rother, W., Leiberich, P., Tritt, K., et al). The occurrence of posttraumatic stress disorder in patients following intensive care treatment: a cross-sectional study in a random sample. J Intensive Care Med, 19(5), 285–290. https://doi/10.1177/0885066604267684.
Rosendahl, J., Kisyova, H., Gawlytta, R., & Scherag, A. (n.d.). Comparative validation of three screening instruments for posttraumatic stress disorder after intensive care. J Crit Care, 53, 149–154. https://doi/10.1016/j.jcrc.2019.06.016.
- Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment.Intensive Care Med. 1999; 25: 697-704https://doi.org/10.1007/s001340050932
- Detection of posttraumatic stress symptoms in patients after discharge from intensive care.Am J Crit Care. 2016; 25: 509-515https://doi.org/10.4037/ajcc2016573
- Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients.Acta Anaesthesiol Scand. 2008; 52: 202-208https://doi.org/10.1111/j.1399-6576.2007.01531.x
- Posttraumatic stress disorder in survivors of acute lung injury: evaluating the impact of event scale-revised.Chest. 2013; 144: 24-31https://doi.org/10.1378/chest.12-0908
- Screening for posttraumatic stress disorder in ARDS survivors: validation of the Impact of Event Scale-6 (IES-6).Crit Care. 2019; 23: 276https://doi.org/10.1186/s13054-019-2553-z
- Psychological problems following ICU treatment.Anaesthesia. 2001; 56: 9-14
- Pilot exploration of post-traumatic stress symptoms in intensive care unit survivors in Cyprus.Nurs Crit Care. 2021; 26: 109-117https://doi.org/10.1111/nicc.12574
Parsons, E. C., Palen, B., Hough, C. L., Vitiello, M. V., Zatzick, D., & Davydow, D. S. (n.d.). Validity of a single PTSD checklist item to screen for insomnia in survivors of critical illness. Heart Lung, 47(2), 87–92. https://doi/10.1016/j.hrtlng.2017.12.006.
- CAESAR: a new tool to assess relatives' experience of dying and death in the ICU.Intensive Care Med. 2016; 42: 995-1002https://doi.org/10.1007/s00134-016-4260-4
- Society of critical care medicine's international consensus conference on prediction and identification of long-term impairments after critical illness.Crit Care Med. 2020; https://doi.org/10.1097/CCM.0000000000004586
- Interventions in post-intensive care syndrome-family: a systematic literature review.Crit Care Med. 2020; 48: e835-e840https://doi.org/10.1097/CCM.0000000000004450
- Caring for critically ill patients with the ABCDEF bundle: results of the ICU liberation collaborative in over 15,000 adults.Crit Care Med. 2019; 47: 3-14https://doi.org/10.1097/CCM.0000000000003482
- Post-intensive care syndrome: impact, prevention, and management.Breathe. 2019; 15: 98-101https://doi.org/10.1183/20734735.0013-2019
- Long-term outcomes after critical illness: recent insights.Crit Care. 2021; 25: 108https://doi.org/10.1186/s13054-021-03535-3
Article info
Publication history
Published online: December 01, 2022
Accepted:
September 27,
2022
Received in revised form:
September 21,
2022
Received:
June 7,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
