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

Abstract

Objective 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 (CAPD) 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 < 2 years, mechanical ventilation, benzodiazepines, narcotics, use of physical restraints, and exposure to vasopressors and anti-epileptics. 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.

Anticholinergic Medication Burden in Pediatric Prolonged Critical Illness: A Potentially Modifiable Risk Factor for Delirium

“…In a recent review of the literature, we did not identify any studies that had evaluated and characterized anticholinergic burden in the pediatric population ( 12 ). However, studies have examined the incidence of delirium in the PICU as it relates to anticholinergic medication as a dichotomous variable, and reported exposure of 68–74% of subjects to this medication class ( 9 , 17 ). In a recent study examining medications administered to AICU patients, the median number of “low potency” anticholinergic medications was 1.5 in those patients who were never delirious, versus 2.4 in those patients developing delirium (< 0.0001) ( 7 ).…”

“…Benzodiazepines have also long been associated with delirium in critically ill AICU ( 7 , 18 – 20 ) and PICU patients ( 9 , 17 , 21 ). The biologic mechanisms underlying this association are multifactorial.…”

Neurologic Outcomes Following Care in the Pediatric Intensive Care Unit

“…In the ICU, delirium affects up to 80% of critically ill adults, and a recent international point prevalence study of critically ill children revealed that delirium was present in 25% of all children (80). In children admitted to the PICU greater than six days, prevalence increased to 38% (80).…”

“…In the ICU, delirium affects up to 80% of critically ill adults, and a recent international point prevalence study of critically ill children revealed that delirium was present in 25% of all children (80). In children admitted to the PICU greater than six days, prevalence increased to 38% (80). Similar to adults, independent risk factors for delirium in the PICU include benzodiazepines, use of physical restraints and mechanical ventilation (80).…”

“…In children admitted to the PICU greater than six days, prevalence increased to 38% (80). Similar to adults, independent risk factors for delirium in the PICU include benzodiazepines, use of physical restraints and mechanical ventilation (80). PICU length of stay is increased in children with delirium, as is duration of mechanical ventilation (81).…”