PTSD symptoms common after an ICU stay

Patients who have survived a stay in the intensive care unit (ICU) have a greatly increased risk of developing symptoms of post-traumatic stress disorder (PTSD), according to a new study presented at the 2014 American Thoracic Society International Conference.

"An ICU stay can be traumatic for both patients and their families," said Ann M. Parker, MD, a Pulmonary and Critical Care Medicine fellow at Johns Hopkins University in Baltimore, Maryland. "In our analysis of more than 3,400 ICU patients, we found that one quarter of ICU survivors exhibited symptoms of PTSD." The systematic review of 28 studies involved a total of 3,428 adult ICU survivors. Evaluation included testing with validated PTSD instruments, most commonly the Impact of Events Scale (IES, score range 0-75), administered one month or more after the ICU stay.

In a subset of 429 patients assessed 1-6 months after their stay in the ICU, meta-analysis demonstrated the pooled prevalence of PTSD symptoms was 23% at an IES threshold of ≥35 and 42% at a threshold of ≥20. In 698 patients assessed at 7-12 months, corresponding pooled PTSD prevalence rates were 17% and 34%. Rates in other studies included in the analysis ranged from 5% to 62%.

Risk factors for the occurrence of PTSD symptoms included younger age, use of benzodiazepines and/or mechanical ventilation during the ICU stay, and post-ICU memories of frightening ICU experiences. In some studies of European ICU patients, keeping an ICU diary significantly reduced the occurrence of PTSD symptoms.

Importantly, 3 of 3 studies demonstrated that more PTSD symptoms were associated with worse health-related quality of life.

A potential limitation of this systematic review is the variability of patient populations and PTSD survey instruments studied, which makes direct comparison between studies difficult.

The Diagnostic and Statistical Manual, 4th Edition, Text Revision (DSM) published by the American Psychiatric Association provides the internationally accepted diagnostic criteria for PTSD. There are more than 20 signs and symptoms of PTSD, but the DSM groups them into six diagnostic criteria. All of the criteria must be met for a valid diagnosis. Usually, only the first four diagnostic criteria are in dispute in an insurance claim.

Criterion A is what distinguishes PTSD from other anxiety disorders. It requires that the claimant be exposed to a traumatic event in which both of the following are true: (1) There was actual or threatened death or serious injury to self or others; and (2) the claimant’s response involved intense fear, helplessness or horror. Although the development of PTSD can be delayed, an intense response must occur at the time of the trauma to satisfy DSM Criterion A(2).

Criterion B requires re-experiencing the traumatic event. Distressing recollections are common after any upsetting event, even a bad date, and are not sufficient to satisfy the criterion. For claimants with PTSD, these memories intrude upon their daily affairs and their dreams at night. They act or feel as if the event is recurring. They become overwhelmed by intense physical and mental symptoms when confronting reminders of the traumatic event.