Delirium in Children Undergoing Hematopoietic Cell Transplantation: A Multi-Institutional Point Prevalence Study

Abstract

Introduction: Delirium occurs frequently in adults undergoing hematopoietic cell transplantation, with significant associated morbidity. Little is known about the burden of delirium in children in the peri-transplant period. This study was designed to determine delirium rates, define risk factors (demographic and treatment related), and establish feasibility of multi-institutional bedside screening for delirium in children undergoing hematopoietic cell transplant.Methods: This is a multi-institutional point prevalence study. All subjects were prospectively screened for delirium twice daily using the Cornell Assessment of Pediatric Delirium over a 10-day period. De-identified data, including basic demographics and daily characteristics, were extracted from the electronic medical record.Results: Eleven North American institutions were included, 106 children were enrolled, and 883 hospital days were captured. Delirium screening was successfully completed on more than 98% of the study days. Forty-eight children (45%) developed delirium over the course of the 10-day study. Children were diagnosed with delirium on 161/883 study days, for an overall delirium rate of 18% per day. Higher delirium rates were noted in children <5 years old (aOR 0.41 for children over 5 years), and in association with specific medications (melatonin, steroids, and tacrolimus).Conclusion: Delirium was a frequent occurrence in our study cohort, with identifiable risk factors. Delirium screening is highly feasible in the pediatric hematopoietic cell transplant patient population. A large-scale prospective longitudinal study following children throughout their transplant course is urgently needed to fully describe the epidemiology of pediatric delirium, explore the effects of delirium on patient outcomes, and establish guidelines to prevent and treat delirium in the peri-transplant period.

The Use of Psychotropic Medication in Pediatric Oncology for Acute Psychological and Psychiatric Problems: Balancing Risks and Benefits

“…In general, the treatment of delirium requires an accurate diagnosis, continued monitoring and re-evaluation, therapeutic intervention for hyperactive manifestations that may cause the patient damage, avoidance of risk factors that may worsen delirium severity, and, if possible, diagnosis and treatment of the underlying etiology [ 24 , 26 , 60 , 61 , 62 , 63 , 64 ] ( Table 1 ). Haloperidol is the most frequently prescribed antipsychotic for the treatment of delirium [ 65 , 66 , 67 , 68 , 69 ].…”

Delirium in a patient with trisomy 21 undergoing chemotherapy for high‐risk acute lymphoblastic leukemia

“…[1][2][3] It may be underdiagnosed in pediatric patients, particularly when screening tools are not routinely applied. [4][5][6][7] Delirium-related consequences include longer admissions, higher healthcare costs, and heightened impacts on patient quality of life and development. 1,5,7,8 We present the case of a patient diagnosed with delirium while being treated for acute lymphoblastic leukemia (ALL).…”

“…The incidence of delirium in the pediatric hematology-oncology (PHO) population has been reported as 20%-45%. 3,5,6 These patients are at high risk given exposure to many possible triggers, including repeated hospital admissions, treatments with systemic and intrathecal chemotherapy, and exposure to multiple other medications. Other factors include young age (less than 5 years), brain tumor diagnosis, postoperative status, or benzodiazepine treatment.…”

“…Other factors include young age (less than 5 years), brain tumor diagnosis, postoperative status, or benzodiazepine treatment. 3,6 The evidence for chemotherapy as a cause of delirium is inconsistent between adult and pediatric studies. Two pediatric studies have demonstrated that neither chemotherapy nor steroid administration is significantly associated with delirium.…”

“…Two pediatric studies have demonstrated that neither chemotherapy nor steroid administration is significantly associated with delirium. 6,7 However, evidence in the adult population points to these as possible causes. 10 The pathophysiology of delirium is complex and multifactorial.…”