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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 9 of 9 Research Studies Displayed
Poppert Cordts KM, Hall TA, Hartman ME
Sleep measure validation in a pediatric neurocritical care acquired brain injury population.
Lingering morbidities including physical, cognitive, emotional, and psychosocial sequelae, termed the Post-Intensive Care Syndrome, persist years after pediatric neurocritical care (PNCC) hospitalization. Sleep disturbances impact other Post-Intensive Care Syndrome domains and are under-evaluated to date due to a lack of appropriate measurement tools. The present study evaluated the validity of the Sleep Disturbance Scale for Children (SDSC) to address the growing need for assessing sleep problems after PNCC.
Citation: Poppert Cordts KM, Hall TA, Hartman ME . Sleep measure validation in a pediatric neurocritical care acquired brain injury population. Neurocrit Care 2020 Aug;33(1):196-206. doi: 10.1007/s12028-019-00883-5..
Keywords: Children/Adolescents, Sleep Problems, Neurological Disorders, Intensive Care Unit (ICU), Hospitalization, Quality of Life
Hartman ME, Williams CN, Hall TA
Post-intensive-care syndrome for the pediatric neurologist.
The investigators are working to create awareness and help mitigate post-intensive-care syndrome in pediatric patients who had experienced primary neurological injury and also help their parents and siblings. In this paper they review current knowledge regarding post-intensive-care syndrome in pediatrics and its risk factors. They describe their experience establishing Pediatric Neurocritical Care Recovery Programs at two large academic centers. They also provide a battery of validated tests to identify and manage the different aspects of post-intensive-care syndrome in pediatrics.
Citation: Hartman ME, Williams CN, Hall TA . Post-intensive-care syndrome for the pediatric neurologist. Pediatr Neurol 2020 Jul;108:47-53. doi: 10.1016/j.pediatrneurol.2020.02.003..
Keywords: Children/Adolescents, Neurological Disorders, Intensive Care Unit (ICU), Critical Care, Risk
Andrews PS, Wang S, Perkins AJ
Relationship between intensive care unit delirium severity and 2-year mortality and health care utilization.
Critical care patients with delirium are at an increased risk of functional decline and mortality long term. The objective of this study was to determine the relationship between delirium severity in the intensive care unit and mortality and acute health care utilization within 2 years after hospital discharge. The investigators concluded that increased delirium severity and days of delirium or coma were associated with higher mortality risk 2 years after discharge.
AHRQ-funded; P30 HS024384.
Citation: Andrews PS, Wang S, Perkins AJ . Relationship between intensive care unit delirium severity and 2-year mortality and health care utilization. Am J Crit Care 2020 Jul 1;29(4):311-17. doi: 10.4037/ajcc2020498..
Keywords: Intensive Care Unit (ICU), Neurological Disorders, Mortality, Risk
Khan SH, Xu C, Purpura R
Decreasing delirium through music: a randomized pilot trial.
This randomized controlled trial examined the use of music to decrease delirium in intensive care unit (ICU) patients. Patients were either provided personalized music (PM), slow-tempo music (STM), or an audiobook (for attention control). They were provided noise-cancelling headphones and used mp3 plays to listen to their music/audiobook for 1-hour sessions twice daily up to 7 days. Delirium and delirium severity were assessed twice daily using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Out of 1589 patients screen, 117 (7.4%) were eligible. Of those 52 were randomized between the three groups. Adherence was higher in the groups listening to music and 80% of patients surveyed rated the music as enjoyable. Median rates of delirium/coma-free days by day 7 was 2 for PM, 3 for STM, and 2 for AC. Medium delirium severity rates (from 1-7) was 5.5 for PM, 3.5 for STM, and 4 for AC.
Citation: Khan SH, Xu C, Purpura R . Decreasing delirium through music: a randomized pilot trial. Am J Crit Care 2020 Mar 1;29(2):e31-e38. doi: 10.4037/ajcc2020175..
Keywords: Intensive Care Unit (ICU), Inpatient Care, Neurological Disorders, Prevention, Hospitals
Williams CN, Eriksson CO, Kirby A
Hospital mortality and functional outcomes in pediatric neurocritical care.
Pediatric neurocritical care (PNCC) outcomes research is scarce. In this study, the investigators aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses. The investigators concluded that PNCC patients had high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability were affected, underscoring the ongoing multidisciplinary health care needs of survivors.
Citation: Williams CN, Eriksson CO, Kirby A . Hospital mortality and functional outcomes in pediatric neurocritical care. Hosp Pediatr 2019 Dec;9(12):958-66. doi: 10.1542/hpeds.2019-0173..
Keywords: Children/Adolescents, Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Neurological Disorders, Mortality, Hospitals, Inpatient Care, Outcomes, Patient-Centered Outcomes Research
Wang S, Allen D, Perkins A
Validation of a new clinical tool for post-intensive care syndrome.
The objective of this study was to validate the self-report version of the Healthy Aging Brain Care Monitor as a clinical tool for detecting post-intensive care syndrome. 142 patients who survived stays in intensive care units (ICUs) following a critical illness completed the self-report and standardized assessments of their cognition, their psychological symptoms, and physical functioning. Patients who had post-ICU syndrome were compared with a sample of primary care patients. Based on their findings, the researchers conclude that the self-report version is a valid clinical tool for the assessment of symptoms of post-ICU syndrome.
Citation: Wang S, Allen D, Perkins A . Validation of a new clinical tool for post-intensive care syndrome. Am J Crit Care 2019 Jan;28(1):10-18. doi: 10.4037/ajcc2019639..
Keywords: Diagnostic Safety and Quality, Intensive Care Unit (ICU), Neurological Disorders, Patient Safety
Cognitive impairment, anesthesia, and critical illness: learning from the past to gain perspective on the future.
This study examined the link between cognitive impairment, ICU admission and anesthesia. The author’s hypothesis was that patients with cognitive impairment would be more likely to undergo surgical procedures. However, analysis using data from the Mayo Clinical Study on Aging on 1,977 cognitive normal patients, 387 patients with mild cognitive impairment (MCI), and 72 patients with established dementia found that patients with MCI were more likely to undergo anesthesia and those with dementia were less likely to undergo procedural anesthesia. The author hypothesizes this may be linked to impaired decision-making of the patient and the risk-benefit analysis of performing surgery on patients with established dementia. However, ICU admissions were increased in patients with MCI and dementia.
Citation: Barbash IJ . Cognitive impairment, anesthesia, and critical illness: learning from the past to gain perspective on the future. Mayo Clin Proc 2018 Nov;93(11):1537-39. doi: 10.1016/j.mayocp.2018.09.007..
Keywords: Adverse Events, Critical Care, Medication, Intensive Care Unit (ICU), Neurological Disorders
Mahmoud L, Zullo AR, Thompson BB
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Researchers conducted a retrospective cohort study of 1197 mechanically ventilated patients admitted to a 12-bed neurocritical care unit (NCCU) over four years in order to evaluate the effect of an analgesia-based sedation protocol on medication use and costs in the NCCU. The protocol resulted in increased in fentanyl use and decreased in propofol use, but their findings indicate no effect on healthcare utilization, healthcare costs, or in-hospital mortality. Based on these results, the researchers suggest that similar NCCUs should consider using population-specific protocols to manage analgesia and sedation.
Citation: Mahmoud L, Zullo AR, Thompson BB . Outcomes of protocolised analgesia and sedation in a neurocritical care unit. Brain Inj 2018;32(7):941-47. doi: 10.1080/02699052.2018.1469167..
Keywords: Care Management, Brain Injury, Critical Care, Healthcare Costs, Intensive Care Unit (ICU), Medication, Neurological Disorders, Outcomes, Patient-Centered Outcomes Research, Value
Wang S, Hammes J, Khan S
Improving Recovery and Outcomes Every Day after the ICU (IMPROVE): study protocol for a randomized controlled trial.
The Improving Recovery and Outcomes Every Day after the ICU (IMPROVE) trial is an ongoing clinical trial which evaluates the efficacy of a combined physical exercise and cognitive training on cognitive function among ICU survivors 50 years and older who experienced delirium during an ICU stay. This article describes the study protocol for IMPROVE.
Citation: Wang S, Hammes J, Khan S . Improving Recovery and Outcomes Every Day after the ICU (IMPROVE): study protocol for a randomized controlled trial. Trials 2018 Mar 27;19(1):196. doi: 10.1186/s13063-018-2569-8.
Keywords: Critical Care, Elderly, Intensive Care Unit (ICU), Neurological Disorders, Patient-Centered Outcomes Research