Low Prevalence of New Mental Health Visits Following PICU Admission: A Multi-Institution Study

Monday, February 24, 2025

11:05am – 12:05pm Eastern Time

Location: Connections Central Theater 1

Adam Dziorny, MD, PhD

Golisano Children's Hospital University of Rochester

Disclosure information not submitted.
NP

Neethi Pinto, MD

Attending Physician
Children's Hospital of Philadelphia

Disclosure information not submitted.
Robert B. Lindell, MD

Childrens Hospital of Philadelphia

Disclosure(s): No relevant financial relationship(s) to disclose.
KB

Katherine Brown, PhD

Postdoctoral Research Fellow Department of Biomedical Informatics
Vanderbilt University

Disclosure information not submitted.
AP

Albert Park, PhD

Assistant Professor, Department of Software and Information Systems
UNC Charlotte

Disclosure information not submitted.
ES

Emre Sezgin, PhD

Assistant Professor, Pediatrics
Nationwide Children's Hospital

Disclosure information not submitted.
MD

Mariah DeSerisy, PhD

Assistant Professor, Dept of Psychiatry
Columbia University

Disclosure information not submitted.

Disclosure(s):

Robert B. Lindell, MD: No relevant financial relationship(s) to disclose.

Introduction: Post-intensive care syndrome in pediatrics (PICS-p) includes emotional health sequelae that can manifest as psychiatric symptoms. For example, post-traumatic stress is reported in up to 64% of PICU patients. While parents of PICU patients demonstrate high rates of new mental health (MH) diagnoses, little is known about the extent of patient post-ICU MH follow-up visits. We hypothesized that PICU survivors would rarely initiate new MH visits, and that the rate would vary by center.

Methods: At two sites, we identified patients admitted to the PICU or CICU (2013-2021) who maintained follow-up in the institution’s health system (having >1 outpatient appointment in two years following discharge). We also identified patients discharged from pediatric wards as a control group. Newly-initiated MH visits were defined as visits with a MH provider within 2 years of ICU admit, in patients who had not had a MH visit in the 2 years prior. We identified counts (%) of patients with newly-initiated MH visits, and compared sites and groups by Chi square test.

Results: We identified 44,195 ICU discharges among 28,033 unique patients across the both sites. Among ICU discharges, 37,391 (84.6%) were considered active in the institutional health system in the two years following ICU admission (Site A: 79.1%; Site B: 86.6%). At each health system, a small proportion of patients [Site A: 458 (4.9%); Site B: 4331 (15.4%), p< 0.001 between sites] were seen by MH providers and even fewer [Site A: 321 (3.4%); Site B: 3451 (12.3%), p< 0.001 between sites] were newly-initiated MH visits. Sensitivity analysis limiting ICU admission cohort to those >2 years of age showed similar proportions within each institution and were also significantly different by site. At Site A, these proportions were similar when comparing PICU and pediatric ward patients’ MH visits; however, at Site B significantly fewer ward patients had MH visits [9077 / 102,652 (8.8%), p< 0.01].

Conclusions: Despite the high burden of psychiatric symptoms following ICU admission, very few patients ( < 13%) receive new mental health services. Site-specific differences exist both in ICU patient MH follow-up and when compared to pediatric ward patients. Opportunities exist to understand these differences and narrow the gap between disease, referral, and follow-up.