Factors Associated With Delirium in Children: A Systematic Review and Meta-Analysis*

Abstract

OBJECTIVES: Pediatric delirium (PD) is a neuropsychiatric syndrome caused by a complex interplay between predisposing factors (e.g., age, cognitive impairment), acute illness, and environmental triggers. PD is associated with substantial morbidity and mortality. The objective of this study is to systematically review and evaluate factors associated with PD in hospitalized pediatric patients. DATA SOURCES:A systematic search of PubMed, Embase, Ovid Medline, Webof-Science, Cochrane, CIHNAL, and Google Scholar databases was conducted for relevant studies . STUDY SELECTION:We included studies that compared pediatric patients with and without delirium. Reviews, editorials, congress abstracts, or studies that did not report factors for PD were excluded. No restrictions were imposed on language.DATA EXTRACTION: Title and abstract were independently screened by two reviewers. Individual characteristics, study design, and outcomes were independently extracted.DATA SYNTHESIS: Categorical dichotomous data were summarized across groups using Mantel-Haenszel odds ratios (ORs) with 95% 95% CIs. Either fixedeffect or random effects models were used as indicated by the results of a heterogeneity test. Of 1,846 abstracts, 24 studies were included. We identified 54 factors studied in univariate analyses, and 27 of these were associated with PD in multivariable analyses. In pooled analyses, greater odds of PD were associated with developmental delay (

Editor’s Choice Articles for May

“…Ista E, Traube C, de Neef M, et al; Dutch Multidisciplinary Pediatric Delirium Guideline Group: Factors Associated With Delirium in Children: A Systematic Review and Meta-Analysis (8).…”

“…The authors describe information from 24 studies in which 54 factors were found associated with delirium. In the meta-analysis these findings are reduced to seven factors associated with greater odds of developing delirium during pediatric critical illness (8). In the accompanying editorial our writers propose that it is time to include delirium screening as part of our “vital sign” monitoring (9).…”

Delirium: The Next Vital Sign in the PICU?*

“…Ista et al (12), a team comprised of well-established and prominent leaders in the field of pediatric delirium, present the findings of an important meta-analysis on delirium in the PICU, reporting risk factors for developing delirium during pediatric critical illness. By including 24 studies and more than 10,000 pediatric patients in their review, the authors identified seven risk factors associated with greater odds of developing delirium.…”

“…Of these, only one, the presence of developmental delay, was nonmodifiable. The remaining six risk factors were modifiable and these included (in descending order according to the magnitude of the strength of their association with the odds of developing delirium): need for mechanical ventilation, use of physical restraints, use of benzodiazepines, vasoactive medications, opiates, or steroids (12).…”

“…Further studies to refine our screening process, delirium severity stratification and diagnostic tools for delirium are still needed. Ista et al (12) have provided some preliminary direction for us to search for the answer to the second question. The identification of risk factors associated with delirium will assist critical care practitioners to alter their management strategies to prevent and treat delirium.…”