Studies indicate that medical procedures may cause post-traumatic stress (PTS) symptoms (fear, avoidance, irritability) in children. It is suggested that midazolam hydrochloride, a sedative/amnesic medication used in pediatric intensive care units (PICU), may prevent the development of PTS symptoms. This study examined if PTS symptoms are related to procedural invasiveness (PI) and whether midazolam has a moderating effect.
English-speaking children ages 8-16 (n=20) who had been in the PICU for at least 3 days were recruited at Loma Linda University Children’s Hospital. During the first assessment self-report measures of PTS and PI were administered. One month later children were contacted for follow-up.
Most children (n=19) reported moderate to high levels of stress. Boys (8-12 and 13-16) and girls (13-16) reported higher anxiety levels than the norming population (mean=7.7 vs. 6.1, 6.5 vs. 4.5, and 7.5 vs. 7.0, respectively). Older girls had significantly higher level of PTS (mean=12.8 vs. 9.9). A moderate relationship existed between PI and level of depression (r=0.562, p<.01) and PI and anger (r=0.50, p<.02). The non-midazolam group demonstrated less PTS at first assessment, however, only the midazolam group demonstrated a clinically significant decrease in PTS (17%), anxiety (24%), dissociation (28%), and overt dissociation (44%) at follow-up. There was a moderate effect size in the interaction between midazolam and assessment time.CONCLUSIONS: Children in the PICU experienced PTS symptoms. midazolam had a moderating effect on the symptoms reported one month after the first assessment. While children tended to under-report symptoms, overall results revealed strong indicators of stress. Due to small sample size, generalizability is limited. However, further investigations are warranted.CLINICAL IMPLICATIONS: Children report PTS. Symptoms seem to decline if midazolam was administered before an invasive procedure. Critical care units may utilize this information in improving physical and psychological sequalae of medical interventions.
L. Zaytsev, None.