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865: ACUTE STRESS IN PARENTS AND CAREGIVERS OF PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: Acute stress disorder (ASD) develops during the month following a traumatic event. We hypothesize higher severity of illness scores predict the development of ASD and ASD symptoms in caregivers of pediatric ICU (PICU) patients. We also aim to discern the specific patient and caregiver factors associated with ASD. Methods: In this prospective study, the inclusion criteria were caregivers of children < 17 yrs old with an unexpected admission. The exclusion criteria were children admitted to the PICU for < 48 hrs; caregivers not literate in English; and children with suspected or confirmed abuse, suspected imminent death, or brain death. Subjects completed the Acute Stress Disorder Scale (ASDS-5) at PICU discharge. We defined ASD based on the ASDS-5 standard, in contrast to ASD symptoms which was defined as a total ASDS-5 score greater than 28 out of 70. Patient covariates analyzed include: age, length of stay, PRISM III score, cardiovascular support and new invasive ventilation. Subject covariates analyzed include: age, gender, education level, income, prior exposure to abuse or a major disaster. Bivariate analysis was performed using χ2, Fisher exact, and Mann Whitney rank methods. Multivariate analysis was performed using logistic regression after assessment for collinearity. Results: Of 131 subjects, 13.7% met criteria for ASD and 42% reported ASD symptoms. From the bivariate analysis the diagnosis of ASD was significantly related to both the PRISM III score (p < 0.01) and previous exposure with a major disaster (p = 0.04). In the multivariate model only major disaster was associated with ASD diagnosis OR: 2.90 (1.01,8.38). In contrast, ASD symptoms were significantly associated with parental exposure to abuse (p = 0.01), major disaster (p = 0.01), higher PRISM III score (p < 0.01) and use of cardiovascular support (p = 0.01) in the bivariate analysis. After adjustment, PRISM III score OR: 1.10 (1.00,1.21) and major disaster OR: 2.74 (1.16,6.49) maintained association with ASD symptoms. Conclusions: Although severity of illness was not associated with full ASD diagnostic criteria, it was associated with having symptoms of ASD. Given the large amount of caregivers experiencing ASD symptoms, it will be important to understand how often these symptoms persist and affect the dynamics of the family environment.