Newswise — A questionnaire developed by dementia experts may help clinicians rapidly assess patients recovering from critical illness for the cognitive, psychological and physical impairments collectively known as post-intensive care syndrome (PICS).
More than half of those who survive critical illness are estimated to experience the effects of PICS, with a wide range of symptoms that may persist long after leaving the intensive care unit (ICU). A significant barrier in the detection of PICS is the lack of a single, validated clinical tool to quickly evaluate patients for impairments in all three domains of the syndrome.
An interdisciplinary team from Indiana University School of Medicine and the Indiana University Center for Aging Research at Regenstrief Institute in Indianapolis initially developed the Healthy Aging Brain Care Monitor (HABC-M) questionnaire to evaluate cognitive, functional and psychological function in older adults.
The questionnaire was initially validated with patients who had a score greater than 17 on the Mini-Mental State Examination, a widely used test of cognitive function among older patients. The HABC-M has also been validated in older patients with normal cognition, mild cognitive impairment, early state dementia and late-life depression.
To complete the HABC-M, patients answer questions about their perceived frequency of various symptoms during the previous two weeks, rating each of the 27 items on a scale of zero to three. A higher score indicates more frequency and greater severity of symptoms, with 81 as the highest possible score. The screening tool can be administered face-to-face, via telephone or via the internet.
In “Validation of a New Clinical Tool for Post-Intensive Care Syndrome,” the researchers focused on the validity of face-to-face administration of the self-report version of the questionnaire (HABC-M SR) as a rapid assessment tool for PICS. The study is published in the January issue of American Journal of Critical Care (AJCC).
“In an era of subspecialized care, the full spectrum of PICS symptoms may not be detected after the hospital stay,” said co-author Sophia Wang, MD, an assistant professor of clinical psychiatry at IU School of Medicine. “Regardless of age, most ICU survivors return to a primary care provider for post-hospital care, and healthcare professionals with little to no expertise in PICS need an easy-to-use tool to recognize when patients are experiencing symptoms related to their critical illness.”
The HABC-M SR requires little to no training for healthcare professionals to administer, can be completed within five minutes and can be administered in a wide variety of settings, including primary care and outpatient environments. It can also be repeated to assess a patient’s PICS symptoms over time.
For the study, 261 patients were recruited from July 2011 to May 2017 at the Critical Care Recovery Center (CCRC) at the Sidney & Lois Eskenazi Hospital in Indianapolis, one of the first ICU adult survivor clinics in the United States. The final sample included a subgroup of 142 patients who completed the standardized assessments given to all patients at the recovery center during their initial visit, and who had completed the HABC-M SR questionnaire either that day or within a week. The standardized assessments are a variety of common clinical tools used to separately examine cognition, psychological symptoms and functional levels.
A separate set of 291 patients seen in primary care settings also completed the HABC-M SR questionnaire. The research team found that these patients were more likely to report no cognitive, psychological or functional symptoms than were the CCRC patients.
Patients with PICS had significantly worse scores on subscales than did primary care patients, with mean total HABC-M SR scores for CCRC patients nearly double those for the primary care patients.
The total scale and all subscales had good to excellent internal consistency. Scores on each subscale correlated to various degrees with associated standardized measures; the psychological subscale had the strongest correlation with related assessments.
The findings lay the groundwork for future development of self-report cognitive scales for PICS, similar to those being developed and studied for Alzheimer disease and dementia.
To access the articles and full-text PDF, visit the AJCC website at www.ajcconline.org.
About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based-practice applications. Established in 1992, the award-winning journal includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of more than 120,000 acute and critical care nurses and can be accessed at www.ajcconline.org.
About the American Association of Critical-Care Nurses: Founded in 1969 with 400 members, the American Association of Critical-Care Nurses (AACN) is now the world’s largest specialty nursing organization. In 2019, AACN celebrates 50 years of acute and critical care nursing excellence, serving more than 120,000 members and over 200 chapters in the United States. The organization remains committed to its vision of creating a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. During its 50th anniversary year, AACN continues to salute and celebrate all that nurses have accomplished over the last half century, while honoring their past, present and future impact on the evolution of high-acuity and critical care nursing.
American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109;
949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme