TY - JOUR
T1 - The association of severe pain experienced in the pediatric intensive care unit and postdischarge health-related quality of life
T2 - A retrospective cohort study
AU - Smith, Mallory B.
AU - Killien, Elizabeth Y.
AU - Dervan, Leslie A.
AU - Rivara, Frederick P.
AU - Weiss, Noel S.
AU - Watson, Robert Scott
N1 - Publisher Copyright:
© 2022 John Wiley & Sons Ltd.
PY - 2022/8
Y1 - 2022/8
N2 - Background: Pain may be a modifiable risk factor for lower health-related quality of life after pediatric critical illness. Aim: To evaluate the association between severe pain experienced in the (pediatrc intensive care unit) and postdischarge health-related quality of life. Methods: This was a retrospective cohort study. Children aged 1 month to 18 years admitted to the pediatric intensive care unit and enrolled in the Seattle Children's Hospital Outcomes Assessment Program were included. Pain was assessed every 2 h by bedside nursing staff using a behavioral pain scale or numeric pain scale. A day of severe pain was defined as a pediatric intensive care unit day with ≥25% of pain scores ≥7/10. Baseline (preadmission) and postdischarge (median 6 weeks) health-related quality of life was assessed by the Pediatric Quality of Life Inventory (PedsQL™) or the Stein Jessop Functional Status II-R (FS II-R, for children with developmental disability). The cohort was stratified by diagnosis category (surgical vs. medical), and associations were measured using linear regression models. Results: Among 546 patients, 11.9% experienced ≥1 day of severe pain. In multivariable linear regression, each day of severe pain was independently associated with a lower postdischarge health-related quality of life score by 3.6 points (95% CI −6.3 to −0.9) adjusted for baseline health-related quality of life score, age, baseline cognitive function, days with multi-organ dysfunction, pediatric intensive care unit length of stay, and decline in overall function. This association was stronger among surgical patients than medical patients with each day of severe pain resulting in a lower postdischarge health-related quality of life score by 5.3 points (95% CI −9.6 to −0.9) versus 2.6 points (95% CI −5.8 to 0.6). Surgical patients had lower postdischarge emotional functioning than physical functioning subdomain scores. Conclusions: Children who experience severe pain in the pediatric intensive care unit have lower postdischarge health-related quality of life adjusting for baseline health-related quality of life, particularly among children who have undergone surgery. Attention to pain management may be important to improve postdischarge health-related quality of life.
AB - Background: Pain may be a modifiable risk factor for lower health-related quality of life after pediatric critical illness. Aim: To evaluate the association between severe pain experienced in the (pediatrc intensive care unit) and postdischarge health-related quality of life. Methods: This was a retrospective cohort study. Children aged 1 month to 18 years admitted to the pediatric intensive care unit and enrolled in the Seattle Children's Hospital Outcomes Assessment Program were included. Pain was assessed every 2 h by bedside nursing staff using a behavioral pain scale or numeric pain scale. A day of severe pain was defined as a pediatric intensive care unit day with ≥25% of pain scores ≥7/10. Baseline (preadmission) and postdischarge (median 6 weeks) health-related quality of life was assessed by the Pediatric Quality of Life Inventory (PedsQL™) or the Stein Jessop Functional Status II-R (FS II-R, for children with developmental disability). The cohort was stratified by diagnosis category (surgical vs. medical), and associations were measured using linear regression models. Results: Among 546 patients, 11.9% experienced ≥1 day of severe pain. In multivariable linear regression, each day of severe pain was independently associated with a lower postdischarge health-related quality of life score by 3.6 points (95% CI −6.3 to −0.9) adjusted for baseline health-related quality of life score, age, baseline cognitive function, days with multi-organ dysfunction, pediatric intensive care unit length of stay, and decline in overall function. This association was stronger among surgical patients than medical patients with each day of severe pain resulting in a lower postdischarge health-related quality of life score by 5.3 points (95% CI −9.6 to −0.9) versus 2.6 points (95% CI −5.8 to 0.6). Surgical patients had lower postdischarge emotional functioning than physical functioning subdomain scores. Conclusions: Children who experience severe pain in the pediatric intensive care unit have lower postdischarge health-related quality of life adjusting for baseline health-related quality of life, particularly among children who have undergone surgery. Attention to pain management may be important to improve postdischarge health-related quality of life.
KW - critical care outcomes
KW - health-related quality of life
KW - intensive care units
KW - pain
KW - pediatric
UR - http://www.scopus.com/inward/record.url?scp=85128549951&partnerID=8YFLogxK
U2 - 10.1111/pan.14460
DO - 10.1111/pan.14460
M3 - Article
C2 - 35426458
AN - SCOPUS:85128549951
SN - 1155-5645
VL - 32
SP - 899
EP - 906
JO - Paediatric Anaesthesia
JF - Paediatric Anaesthesia
IS - 8
ER -