Cost Associated With Pediatric Delirium in the ICU

Traube, Chani; Mauer, Elizabeth; Gerber, Linda M.; Kaur, Simranpreet; Joyce, Christine; Kerson, Abigail; Carlo, Charlene; Notterman, Daniel A.; Worgall, Stefan; Silver, Gabrielle; Greenwald, Bruce M.

doi:10.1097/ccm.0000000000002004

Cited by 130 publications

(93 citation statements)

References 26 publications

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“…Over the past decade, there have been increasing reports of delirium in critically ill infants, children, and adolescents (1,(5)(6)(7)(8)(9)(10)(11)(12)(13) as well reports on associated patient outcomes and financial implications (14)(15)(16). Over the past decade, there have been increasing reports of delirium in critically ill infants, children, and adolescents (1,(5)(6)(7)(8)(9)(10)(11)(12)(13) as well reports on associated patient outcomes and financial implications (14)(15)(16).…”

Section: Implementation Of An Icu Bundle: Anmentioning

confidence: 99%

Implementation of an ICU Bundle: An Interprofessional Quality Improvement Project to Enhance Delirium Management and Monitor Delirium Prevalence in a Single PICU*

Simone

Edwards

Lardieri

et al. 2017

Pediatric Critical Care Medicine

108

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Section: Implementation Of An Icu Bundle: Anmentioning

confidence: 99%

Implementation of an ICU Bundle: An Interprofessional Quality Improvement Project to Enhance Delirium Management and Monitor Delirium Prevalence in a Single PICU*

Simone

Edwards

Lardieri

et al. 2017

Pediatric Critical Care Medicine

108

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“…This is one of several planned analyses involving this cohort of patients, and all data described here are novel and have not been published elsewhere. A subset of these patients were included in an analysis of the effect of PD on hospital costs(7). …”

Section: Introductionmentioning

confidence: 99%

Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium*

Traube

Silver

Gerber

et al. 2017

Critical Care Medicine

Self Cite

264

241

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Objective Delirium occurs frequently in adults, and is an independent predictor of mortality. However, the epidemiology and outcomes of pediatric delirium are not well-characterized. The primary objectives of this study were to describe the incidence of delirium in critically ill children, its duration, associated risk factors, and effect on in-hospital outcomes, including mortality. Secondary objectives included determination of delirium subtype, and effect of delirium on duration of mechanical ventilation (MV), and length of hospital stay (LOS). Design Prospective longitudinal cohort study. Setting Urban academic tertiary care pediatric intensive care unit (PICU). Patients All consecutive admissions from September 2014 through August 2015. Intervention Children were screened for delirium twice daily throughout their ICU stay. Measurements and Main Results Of 1547 consecutive patients, delirium was diagnosed in 267 (17%), and lasted a median of two days (IQR 1,5). Seventy-eight percent of children with delirium developed it within the first three PICU days. Most cases of delirium were of the hypoactive (46%) and mixed (45%) subtypes; only 8% of delirium episodes were characterized as hyperactive delirium. In multivariable analysis, independent predictors of delirium included age ≤2 years, developmental delay, severity of illness, prior coma, mechanical ventilation, and receipt of benzodiazepines and anticholinergics. PICU LOS was increased in children with delirium (adjusted relative LOS 2.3, CI= 2.1, 2.5, p<0.001), as was duration of MV (median 4 vs. 1 day, p<0.001). Delirium was a strong and independent predictor of mortality (adjusted OR 4.39, CI= 1.96–9.99, p<0.001). Conclusions Delirium occurs frequently in critically ill children and is independently associated with mortality. Some in-hospital risk factors for delirium development are modifiable. Interventional studies are needed to determine best practices to limit delirium exposure in at-risk children.

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“…[13][14][15] Delirium also carries long-term consequences including impaired physical functioning 16 17 and loss of independence resulting in long-term care placement ,5 caregiver burden, 18 19 decreased quality of life, 20 cognitive decline and increased risk of dementia and Alzheimer's disease. 11 With increased recognition of delirium as a common, costly and potentially preventable condition associated with adverse outcomes, encouragingly studies examining interventions to prevent and/or treat delirium continue to proliferate.…”

Section: Introductionmentioning

confidence: 99%

Development of core outcome sets for effectiveness trials of interventions to prevent and/or treat delirium (Del-COrS): study protocol

et al. 2017

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IntroductionDelirium is a common, serious and potentially preventable condition with devastating impact on the quality of life prompting a proliferation of interventional trials. Core outcome sets aim to standardise outcome reporting by identifying outcomes perceived fundamental for measurement in trials of a specific interest area. Our aim is to develop international consensus on two core outcome sets for trials of interventions to prevent and/or treat delirium, irrespective of study population. We aim to identify additional core outcomes specific to the critically ill, acutely hospitalised patients, palliative care and older adults.Methods and analysisWe will conduct a systematic review of published and ongoing delirium trials (1980 onwards) and one-on-one interviews of patients who have experienced delirium and family members. These data will inform Delphi round 1 of a two-stage consensus process. In round 2, we will provide participants their own response, summarised group responses and those of patient/family participants for rescoring. We will randomise participants to receive feedback as proportion scoring the outcome as critical or as group mean responses. We will hold a consensus meeting using nominal group technique to finalise outcomes for inclusion. We will repeat the Delphi process and consensus meeting to select measures for each core outcome. We will recruit 240 Delphi participants giving us 80% power to detect a 1.0–1.5 point (9-point scale) difference by feedback method between rounds. We will analyse differences for subsequent scores, magnitude of opinion change, items retained and level of agreement.Ethics and disseminationWe are obtaining research ethics approvals according to local governance. Participation will be voluntary and data deidentified. Support from three international delirium organisations will be instrumental in dissemination and core outcome set uptake. We will disseminate through peer-reviewed open access publications and present at conferences selected to reach a wide range of knowledge users.

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Cost Associated With Pediatric Delirium in the ICU

Cited by 130 publications

References 26 publications

Implementation of an ICU Bundle: An Interprofessional Quality Improvement Project to Enhance Delirium Management and Monitor Delirium Prevalence in a Single PICU*

Implementation of an ICU Bundle: An Interprofessional Quality Improvement Project to Enhance Delirium Management and Monitor Delirium Prevalence in a Single PICU*

Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium*

Development of core outcome sets for effectiveness trials of interventions to prevent and/or treat delirium (Del-COrS): study protocol

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