Clinical characteristics, prevalence, and factors related to delirium in children of 5 to 14 years of age admitted to intensive care

Ramírez, Carmenza Ricardo; Gómez, Martín; Vélez, C.A.; Penagos, Susana; Peña, Ricardo; Hernández, Katerine Uribe; Gil, I.C. Mejía; Londoño, E.M. Cano; Parra, Mussatyé Elorza; Vásquez, José Gabriel Franco

doi:10.1016/j.medine.2019.02.004

Cited by 11 publications

(31 citation statements)

References 34 publications

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“…Twenty-seven (16, 18–22, 35, 38–43, 45–59) were prospective in design, two retrospective (36, 37), and two point prevalence (44, 58). Twenty-seven were single-center studies (16, 18–21, 36–43, 45–57, 59), and four were multicenter studies (22, 35, 44, 58), including two multisite point prevalence studies (44, 58). Twenty-seven took place in a PICU (16, 18–22, 35–43, 45–49, 52–54, 56–59), two in a PCICU (51, 55), one in a mixed PICU and PCICU (50), and one across multiple PCICUs or PICUs (44).…”

Section: Resultsmentioning

confidence: 99%

“…The 31 studies reported on 9,756 children. Twenty studies reported prevalence of PD using CAPD (18, 36–38, 40, 41, 43–46, 48, 50, 51, 53–59) or translated versions (40, 45, 46, 48, 53, 54), eight using variations of the pCAM-ICU (16, 19, 20, 35, 39, 47, 49, 52), and three the SOS-PD (21, 22, 42).…”

Section: Resultsmentioning

confidence: 99%

“…Associations between development of PD and emergency admissions (20, 46) and cardiac disease (including cyanotic defects and postoperative state) (21, 51, 55) were also found. Other associations included the following: infections and inflammatory disorders (58), intellectual disability, neurologic and liver impairment (49), the use of physical restraints (37, 46, 55, 58), longer cardiac bypass times (51, 55), use of continuous renal replacement therapy (CRRT) (37, 44, 46), extracorporeal membrane oxygenation (44), and blood transfusions (31). A multisite point prevalence in postoperative cardiothoracic patients reported lack of documented ambulation, physical therapy, and parental presence during scoring as risk factors (44).…”

Section: Resultsmentioning

confidence: 99%

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

Semple

Howlett

Strawbridge

et al. 2021

Critical Care Medicine

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Semple

Howlett

Strawbridge

et al. 2021

Critical Care Medicine

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“…The current study showed that the Pediatric Confusion Assessment Method for the ICU was the most commonly used screening tool for delirium, but this scale is only applicable to children aged >5 years. 22 This is because younger children do not cooperate easily, thereby reducing compliance. In 2016, the European Society of Pediatric and Neonatal Intensive Care recommended use of the Cornell Assessment of pediatric delirium (CAPD) tool for assessing delirium in children (level of evidence A).…”

Section: Discussionmentioning

confidence: 99%

Implementation of the “awakening and breathing trials, choice of drugs, delirium management, and early exercise/mobility” bundle in the pediatric intensive care unit of tertiary hospitals in southwestern China: a cross-sectional survey

et al. 2021

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Objective To investigate management and implementation of the “awakening and breathing trials, choice of drugs, delirium management, and early exercise/mobility” (ABCDE) bundle in the pediatric intensive care unit (PICU) in southwestern China Methods A self-designed questionnaire for determining implementation of the ABCDE bundle was distributed to healthcare professionals in the PICU. Multiple linear regression was used to analyze results. Results A total of 270 questionnaires were collected. There was no significant difference in the awareness of the ABCDE bundle rate among Sichuan, Guizhou, and Yunnan workers. Only dynamic adjustment of drug dose accounted for more than half (55.5%) of “frequent implementation” and “general implementation”, followed by implementation of sedation assessment, pain assessment, and spontaneous breathing trials (46.4%, 39.3%, and 35.6%, respectively). A total of 80.4% of healthcare professionals never performed screening of delirium. Multivariate analysis showed that the healthcare professionals’ scores of ABCDE bundle behavior significantly differed regarding awareness of the ABCDE bundle, years of work at the hospital, the region of hospitals, and occupational category. Conclusion Implementation of the ABCDE bundle in the PICU in southwestern China is not sufficient. Existing problems need to be identified and a standardized sedation and analgesia management model needs to be established.

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“…This study showed that the prevalence of delirium during ICU/HCU stay was 17.9%, and the prevalence of delirium at the end of the ICU/HCU stay was 5.9%. Previous studies reported the delirium incidence among critically ill adults was 19.6–81.7% 3 – 10 and among critically ill children was 18.6–25% 22 , 23 . Our results on the prevalence of delirium were lower than in previous reports.…”

Section: Discussionmentioning

confidence: 94%

Current status of delirium assessment tools in the intensive care unit: a prospective multicenter observational survey

Ishii

Kuroda

Tokura³

et al. 2022

Sci Rep

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Delirium is a critical challenge in the intensive care unit (ICU) or high care unit (HCU) setting and is associated with poor outcomes. There is not much literature on how many patients in this setting are assessed for delirium and what tools are used. This study investigated the status of delirium assessment tools of patients in the ICU/HCU. We conducted a multicenter prospective observational study among 20 institutions. Data for patients who were admitted to and discharged from the ICU/HCU during a 1-month study period were collected from each institution using a survey sheet. The primary outcome was the usage rate of delirium assessment tools on an institution- and patient-basis. Secondary outcomes were the delirium prevalence assessed by each institution’s assessment tool, comparison of delirium prevalence between delirium assessment tools, delirium prevalence at the end of ICH/HCU stay, and the relationship between potential factors related to delirium and the development of delirium. Result showed that 95% of institutions used the Intensive Care Delirium Screening Checklist (ICDSC) or the Confusion Assessment Method for the ICU (CAM-ICU) to assess delirium in their ICU/HCU, and the remaining one used another assessment scale. The usage rate (at least once during the ICU/HCU stay) of the ICDSC and the CAM-ICU among individual patients were 64.5% and 25.1%, and only 8.2% of enrolled patients were not assessed by any delirium assessment tool. The prevalence of delirium during ICU/HCU stay was 17.9%, and the prevalence of delirium at the end of the ICU/HCU stay was 5.9%. In conclusion, all institutions used delirium assessment tools in the ICU/HCU, and most patients received delirium assessment. The prevalence of delirium was 17.9%, and two-thirds of patients had recovered at discharge from ICU/HCU.Trial registration number: UMIN000037834.

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Clinical characteristics, prevalence, and factors related to delirium in children of 5 to 14 years of age admitted to intensive care

Cited by 11 publications

References 34 publications

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

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

Implementation of the “awakening and breathing trials, choice of drugs, delirium management, and early exercise/mobility” bundle in the pediatric intensive care unit of tertiary hospitals in southwestern China: a cross-sectional survey

Current status of delirium assessment tools in the intensive care unit: a prospective multicenter observational survey

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