Behavioral changes in pediatric intensive care units
S. M. Jones, D. H. Fiser and R. L. Livingston
Department of Pediatrics, Arkansas Children's Hospital, Little Rock 72202-3591.
OBJECTIVE--The purposes of this study were to compare the frequency and
severity of manifestations of anxiety, depression, delirium, and withdrawal
in pediatric patients hospitalized in intensive care unit vs ward settings
and to evaluate the impact of preexisting psychopathologic disorders on the
expression of these symptoms. RESEARCH DESIGN--Prospective patient series.
SETTING--Tertiary care pediatric center. PATIENTS--Forty-three subjects
aged 6 to 17 years hospitalized in either the pediatric or cardiovascular
intensive care unit (n = 18) or on the general wards (n = 25) were
recruited to participate. Subjects were excluded if their parents were
unavailable for diagnostic interview or if they could not answer interview
questions themselves. SELECTION PROCEDURES--Consecutive sample.
INTERVENTIONS--None. MEASUREMENTS AND RESULTS--The Hospital Observed
Behavior Scale, developed for this study, was used to describe objectively
subjects' manifestations of anxiety, depression, delirium, and withdrawal.
The Diagnostic Interview for Children and Adolescents and Diagnostic
Interview for Children and Adolescents-Parents were used to determine the
presence of preexisting psychopathologic disorders. As measured by the
Hospital Observed Behavior Scale, subjects in the intensive care unit
exhibited apprehension, anxiety, detachment, sadness, and weeping more
often than did patients in the ward. Behavior was also significantly
influenced by severity of illness, duration of hospitalization, number of
previous hospitalizations, and presence of a preexisting anxiety or mood
disorder. We found the Hospital Observed Behavior Scale to have good
interrater reliability. CONCLUSIONS--Our data indicate that critically ill
children in the intensive care unit, children with prolonged or repeated
hospitalizations, and children with preexisting anxiety and mood disorders
are at greater risk than other hospitalized pediatric patients for
psychological trauma and/or behavior problems that may warrant psychiatric
intervention. The Hospital Observed Behavior Scale is a reliable tool to
quantitate behaviors in hospitalized children.
