Pediatric Delirium and Associated Risk Factors

Abstract

Objective To describe a single-institution pilot study regarding prevalence and risk factors for delirium in critically ill children. Design A prospective observational study, with secondary analysis of data collected during the validation of a pediatric delirium screening tool, the Cornell Assessment of Pediatric Delirium (CAPD). Setting This study took place in the pediatric intensive care unit (PICU) at an urban academic medical center. Patients 99 consecutive patients, ages newborn to 21 years. Intervention Subjects underwent a psychiatric evaluation for delirium based on the DSM-IV criteria. Measurements and Main Results Prevalence of delirium in this sample was 21%. In multivariate analysis, risk factors associated with the diagnosis of delirium were presence of developmental delay, need for mechanical ventilation, and age 2-5 years. Conclusions In our institution, pediatric delirium is a prevalent problem, with identifiable risk factors. Further large-scale prospective studies are required to explore multi-institutional prevalence, modifiable risk factors, therapeutic interventions, and effect on long-term outcomes.

Delirium in Critically Ill Children: An International Point Prevalence Study*

“…Our findings are consistent with those of prior single-center studies which reported PD rates ranging from 10–30%(14,15,18,20,25). Children requiring MV (likely with an increased exposure to sedatives and higher severity of illness) had a delirium prevalence of 53%.…”

“…PD has been associated with severity of illness, age less than 5 years, sedation, and mechanical ventilation (MV)(18–20). PD has been linked to significant increase in hospital length of stay, and post-traumatic stress symptoms and delusional memories in child survivors(18,21,22). However, most PD research has been limited by retrospective design, narrow inclusion criteria, small number of subjects, and single-center studies(11).…”

“…We hypothesized that delirium prevalence would be >20% overall, and would be more frequent in patients who had been in the ICU for a longer period of time (>3 days) (12,16). We hypothesized that risk factors associated with development of delirium would include mechanical ventilation, sedation (specifically narcotics and benzodiazepines), use of restraints, and younger age (less than 5 years old) (18–20). …”

From Phantasmagoria to Reality?*

“…Patients with severe postoperative delirium experienced a longer duration of mechanical ventilation and length of stay, and this has been seen in previous studies [8, 9]. However, delirious patients did not have a higher severity of illness, which differs from a previous report showing that delirium was associated with a higher PRISM score [10].…”

Meeting the Challenges of Delirium Assessment Across the Aging Spectrum

“…(1) Furthermore, pediatric specific risk factors and outcomes associated with delirium have not been well delineated, though a recent study reveals that patient factors such as developmental delay, duration of mechanical ventilation, and age are associated with delirium during critical illness. (2) Similarly, the underlying mechanism of pediatric delirium has yet to be fully realized and therefore many aspects of delirium management remain in the exploratory phase. These very important but undefined areas of delirium within the very young also remain poorly described in the elderly, particularly in patients with delirium superimposed on dementia.…”