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Crit Care Med. 2017 Apr;45(4):584-590. doi: 10.1097/CCM.0000000000002250.

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

Author information

1
1Weill Cornell Medical College, New York, NY.2University of Utah, Salt Lake City, UT.3The Children's Hospital of Philadelphia, Philadelphia, PA.4Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.5Nationwide Children's Hospital, Columbus, OH.6University of Washington, Seattle, WA.7University of Arizona College of Medicine, Phoenix, AZ.8Johns Hopkins University School of Medicine, Baltimore, MD.9Boston Children's Hospital, Boston, MA.10Washington University in St. Louis, St. Louis, MO.11Emory University School of Medicine, Atlanta, GA.12Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA.13Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.14Connecticut Children's Medical Center, Hartford, CT.15Starship Children's Hospital, Auckland, New Zealand.16Lady Cilento Children's Hospital, Brisbane, Australia.17C.S. Mott Children's Hospital, Ann Arbor, MI.18Duke Children's Hospital, Durham, NC.19Cook Children's Hospital, Fort Worth, TX.20Children's Hospital and Medical Center, Omaha, NE.21University of North Carolina, Chapel Hill, NC.22University of Wisconsin, Madison, WI.23Virginia Commonwealth University, Richmond, VA.24Massachusetts General Hospital, Boston, MA.25Al Hada Armed Forces Hospital, Taif, Saudi Arabia.26University of Pittsburgh, Pittsburgh, PA.

Abstract

OBJECTIVES:

To determine prevalence of delirium in critically ill children and explore associated risk factors.

DESIGN:

Multi-institutional point prevalence study.

SETTING:

Twenty-five pediatric critical care units in the United States, the Netherlands, New Zealand, Australia, and Saudi Arabia.

PATIENTS:

All children admitted to the pediatric critical care units on designated study days (n = 994).

INTERVENTION:

Children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the bedside nurse. Demographic and treatment-related variables were collected.

MEASUREMENTS AND MAIN RESULTS:

Primary study outcome measure was prevalence of delirium. In 159 children, a final determination of mental status could not be ascertained. Of the 835 remaining subjects, 25% screened positive for delirium, 13% were classified as comatose, and 62% were delirium-free and coma-free. Delirium prevalence rates varied significantly with reason for ICU admission, with highest delirium rates found in children admitted with an infectious or inflammatory disorder. For children who were in the PICU for 6 or more days, delirium prevalence rate was 38%. In a multivariate model, risk factors independently associated with development of delirium included age less than 2 years, mechanical ventilation, benzodiazepines, narcotics, use of physical restraints, and exposure to vasopressors and antiepileptics.

CONCLUSIONS:

Delirium is a prevalent complication of critical illness in children, with identifiable risk factors. Further multi-institutional, longitudinal studies are required to investigate effect of delirium on long-term outcomes and possible preventive and treatment measures. Universal delirium screening is practical and can be implemented in pediatric critical care units.

PMID:
28079605
PMCID:
PMC5350030
DOI:
10.1097/CCM.0000000000002250
[Indexed for MEDLINE]
Free PMC Article

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