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The Association Between Patient Health Status and Surrogate Decision Maker PTSD Symptoms in Chronic Critical Illness.

RATIONALE
Surrogate decision makers of patients with chronic critical illness (CCI) are at high risk for symptoms of post-traumatic stress disorder (PTSD). Whether patient health status following hospital discharge is a risk factor for surrogate PTSD symptoms is not known.


OBJECTIVE
To determine the association between patient health status 90 days after the onset of CCI and surrogate symptoms of PTSD.


METHODS
We performed a secondary analysis of the data from a multicenter randomized trial of a communication intervention for adult CCI patients and their surrogate decision makers.


RESULTS
Surrogate PTSD symptoms were measured at 90 days using the Impact of Events Scale Revised (IES-R). For patients who were alive at 90 days, location was used as a marker of health status, with the following categories: 1) Home (relatively good health and low acuity), 2) Acute rehabilitation (moderate care needs and impairments, generally expected to improve), 3) Skilled nursing facility (moderate care needs and impairments, generally not expected to improve significantly or quickly), 4) Long-term acute care facility (persistently high acute care needs and functional impairment), and 5) Readmission to an acute care hospital (suggesting the highest acuity of illness and care needs of the cohort). Patients who died prior to 90 days were categorized as deceased. 365 surrogates and 256 patients were included in analyses. 49% of patients were female, and mean age was 59 years. 71% of surrogates were female, and mean age was 51 years. A directed acyclic graph (DAG) was constructed to identify covariates to be included in the model. Compared to surrogates of patients living at home, heightened PTSD symptoms were seen among surrogates of patients who were readmitted to an acute care hospital (beta coefficient 15.9, 95% CI 4.5 to 27.3) or had died (beta coefficient 14.8, 95% CI 8.8 to 20.9) at 90 days.


CONCLUSIONS
Surrogates of CCI patients who have died or been readmitted to an acute care hospital at 90 days experience increased PTSD symptoms as compared to surrogates of patients who are living at home. These patients and surrogates represent a readily identifiable group who may benefit from enhanced emotional support.