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

Semple, Diarmaid; Howlett, Moninne; Strawbridge, Judith; Breatnach, Cormac; Hayden, John

doi:10.1097/ccm.0000000000005260

Cited by 53 publications

(52 citation statements)

References 67 publications

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“…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].…”

Section: Prevalence and Incidencementioning

confidence: 99%

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

McCluskey

Jackson

2022

Anaesthesia

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Delirium is a common condition affecting hospital inpatients, including those having surgery and on the intensive care unit. Delirium is also common in patients with COVID-19 in hospital settings, and the occurrence is higher than expected for similar infections. The short-term outcomes of those with COVID-19 delirium are similar to that of classical delirium and include increased length of stay and increased mortality. Management of delirium in COVID-19 in the context of a global pandemic is limited by the severity of the syndrome and compounded by the environmental constraints. Practical management includes effective screening, early identification and appropriate treatment aimed at minimising complications and timely escalation decisions. The pandemic has played out on the national stage and the effect of delirium on patients, relatives and healthcare workers remains unknown but evidence from the previous SARS outbreak suggests there may be long-lasting psychological damage.

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Section: Prevalence and Incidencementioning

confidence: 99%

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

McCluskey

Jackson

2022

Anaesthesia

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“…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.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2022

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BackgroundDelirium is an acute brain dysfunction associated with increased length of hospitalization, mortality, and high healthcare costs especially in patients admitted to the pediatric intensive care unit (PICU). The Cornell Assessment of Pediatric Delirium (CAPD) is a screening tool for evaluating delirium in pediatric patients. This tool has already been used and validated in other languages but not in Italian.ObjectivesTo test the reliability of the Italian version of the CAPD to screen PICU patients for delirium and to assess the agreement between CAPD score and PICU physician clinical evaluation of delirium.MethodsProspective double-blinded observational cohort study of patients admitted to a tertiary academic center PICU for at least 48 h from January 2020 to August 2021. We evaluated intra- and inter-rater agreement using the Intraclass Correlation Coefficient (ICC). The ability of the scale to detect delirium was evaluated by comparing the nurses’ CAPD assessments with the clinical evaluation of a PICU physician with expertise in analgosedation using the area under the ROC curve (AUC).Measurements and Main ResultsSeventy patients were included in the study. The prevalence of pediatric delirium was 54% (38/70) when reported by a positive CAPD score and 21% (15/70) when diagnosed by the PICU physician. The CAPD showed high agreement levels both for the intra-rater (ICC 1 0.98, 95% CI: 0.97–0.99) and the inter-rater (ICC 2 0.93, 95% CI: 0.89–0.96) assessments. In patients with suspected delirium according to the CAPD scale, the observed sensitivity and specificity of the scale were 0.93 (95% CI: 0.68–1.00) and 0.56 (95% CI: 0.42–0.70), respectively. The AUC observed was 0.75 (95% CI: 0.66–0.8490).ConclusionThe Italian version of the CAPD seems a reliable tool for the identification of patients at high risk of developing delirium in pediatric critical care settings. Compared to the clinical evaluation of the PICU physician, the use of the CAPD scale avoids a possible underestimation of delirium in the pediatric population.

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“…Delirium affects more than 25% of critically ill children. 1 2 Risk factors associated with delirium include age less than 2 years, mechanical ventilation, and the use of benzodiazepines or opiates. 3 4 5 Delirium in children is important; it decreases quality of life, 6 7 increases hospital length of stay and risk of mortality, 8 9 and raises pediatric intensive care unit (PICU) costs, regardless of length of stay or severity of illness.…”

Section: Introductionmentioning

confidence: 99%

Lived Experiences of Delirium in Critically Ill Children: A Qualitative Study

Moradi

Mikhail

Lee

et al. 2022

J Pediatr Intensive Care

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The aim of this study was to understand the lived experiences of delirium in critically ill children. We conducted phenomenological qualitative interviews with critically ill pediatric survivors aged 0 to 18 years who had experienced delirium, along with their family caregivers and health care providers, from pediatric intensive care units in two tertiary care children's hospitals in Canada. Cases were identified if they had a Cornell Assessment of Pediatric Delirium (CAPD) score of ≥ 9 for at least 48 hours. Thirteen interviews were conducted, representing 10 index patients with delirium (age range: 7 weeks to 17 years). Participants shared experiences that were divided into themes of delirium symptoms, the impact of delirium, and their experience with the care of delirium. Within each theme, subthemes were identified. Symptoms of delirium included hallucinations, fluctuating symptoms, and lack of eye contact. Children were often described as “not himself/herself.” Delirium had long-lasting impact on patients; memories remained prominent even after the hospital stay. Family members and health care providers often felt helpless and ill-prepared to manage delirium. The delirium experience had significant impact on loved ones, causing persistent and vicarious suffering after the critical illness course. Family members and health care providers prioritized nonpharmacological strategies, family presence, and education as key strategies for delirium management. The lived experience of delirium in both infants and older children is physically, psychologically, and emotionally distressing. Given the traumatic long-term consequences, there is an urgent need to target delirium education, management, and prevention to improve long-term outcomes in PICU survivors and their families. Trial Registration number: NCT04168515.

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

Cited by 53 publications

References 67 publications

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

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

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

Lived Experiences of Delirium in Critically Ill Children: A Qualitative Study

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