A Systematic Review and Pooled Prevalence of Delirium in Critically Ill Children*

Abstract

Pediatric delirium is a neuropsychiatric disorder with disrupted cerebral functioning due to underlying disease and/or critical care treatment. Pediatric delirium can be classified as hypoactive, hyperactive, and mixed. This systematic review was conducted to estimate the pooled prevalence of pediatric delirium using validated assessment tools in children (Cornell Assessment of Pediatric Delirium, Pediatric Confusion Assessment Method for the ICU, PreSchool Confusion Assessment Method for the ICU, Pediatric Confusion Assessment Method for the ICU Severity Scale, and Sophia Observation Withdrawal Symptoms Pediatric Delirium scale), identify modifiable and nonmodifiable risk factors, and explore the association of pediatric delirium with clinical outcomes. DATA SOURCES:A systematic search of PubMed, EMBASE, and CINAHL databases was undertaken for full articles pertaining to pediatric delirium prevalence. STUDY SELECTION:No language or date barriers were set. Studies were included where the following eligibility criteria were met: study design aimed to estimate pediatric delirium prevalence arising from treatment in the intensive care setting, using a validated tool. Only randomized controlled trials, cross-sectional studies, or cohort studies allowing an estimate of the prevalence of pediatric delirium were included.DATA EXTRACTION: Data were extracted by the primary researcher (D.S.) and accuracy checked by coauthors. DATA SYNTHESIS:A narrative synthesis and pooled prevalence meta-analysis were undertaken. CONCLUSIONS:Pediatric delirium, as determined by the Cornell Assessment of Pediatric Delirium score, is estimated to occur in 34% of critical care admissions. Eight of 11 studies reporting on subtype identified hypoactive delirium as most prevalent (46-81%) with each of the three remaining reporting either hyperactive (44%), mixed (57%), or equal percentages of hypoactive and mixed delirium (43%) as most prevalent. The development of pediatric delirium is associated with cumulative doses of benzodiazepines, opioids, the number of sedative classes used, deep sedation, and cardiothoracic surgery. Increased time mechanically ventilated, length of stay, mortality, healthcare costs, and associations with decreased quality of life after discharge were also found. Multi-institutional and longitudinal studies are required to better determine the natural history, true prevalence, long-term outcomes, management strategies, and financial implications of pediatric delirium.

Italian Version of the Cornell Assessment of Pediatric Delirium: Evaluation of the Scale Reliability and Ability to Detect Delirium Compared to Pediatric Intensive Care Unit Physicians Clinical Evaluation

“…Furthermore, patients with suspected delirium who were not detected by the PICU physicians were younger and more sedated than the other patients and their diagnosis could have been dismissed by intensivists performing non-standardized assessments. These patients could be suffering hypoactive delirium which has been previously reported as being the most frequent delirium subtype and more difficult to diagnose ( 8 , 27 , 28 ). This issue underlines the need for a screening program training on delirium and its risk factors within the PICU staff which should involve a multidisciplinary team composed of PICU nurses, physicians, and psychiatrists.…”

Delirium and COVID‐19: a narrative review of emerging evidence

“…The prevalence of delirium in hospitalised older adults is estimated at 23% (95%CI 19–26%) [21]. In critical care settings, prevalence ranges from 31% (95%CI 24–41%) in all patients to 50% in mechanically ventilated patients [22], and 34% in critically ill children [23]. Non‐COVID‐19‐related delirium remains underdiagnosed in up to three‐quarters of hospitalised adult patients [24].…”

Four-in-One: A Comprehensive Checklist for the Assessment of Pain, Undersedation, Iatrogenic Withdrawal and Delirium in the PICU: A Delphi Study

“…Delirium in adult ICU patients has long been acknowledged, but not until in the early 2000's healthcare professionals acknowledged the existence of pediatric delirium as well ( 14 – 16 ), whereupon several assessments tools have been validated for infants and children ( 17 – 19 ). The estimated prevalence of pediatric delirium is 34% (range 17–66%, depending on the subgroup studied) ( 20 ). As for pain and undersedation, symptoms of IWS and pediatric delirium may considerably overlap ( 21 , 22 ).…”