The occurrence of delirium diagnosis among youth hospitalizations in the United States: A Kids' Inpatient Database analysis

Abstract

Objectives: Delirium is an acute neuropsychiatric condition associated with increased morbidity and mortality. There is increasing recognition of delirium as a substantial health burden in younger patients, although few studies have characterized its occurrence. This study analyzes the occurrence of delirium diagnosis, its comorbidities, and cost among youth hospitalized in the United States.Methods: The Kids' Inpatient Database, a national all-payers sample of pediatric hospitalizations in general hospitals, was examined for the year 2019.Hospitalizations with a discharge diagnosis of delirium among patients aged 1-20 years were included in the analysis. Results: Delirium was diagnosed in 43,138 hospitalizations (95% CI: 41,170-45,106), or 2.3% of studied hospitalizations. Delirium was diagnosed in a broad range of illnesses, with suicide and self-inflicted injury as the most common primary discharge diagnosis among patients with delirium. In-hospital mortality was seven times greater in hospitalizations caring a delirium diagnosis. The diagnosis of delirium was associated with an adjusted increased hospital cost of $8648 per hospitalization, or $373 million in aggregate cost. Conclusions: Based on a large national claims database, delirium was diagnosed in youth at a lower rate than expected based on prospective studies. The relative absence of delirium diagnosis in claims data may reflect underdiagnosis, a failure to code, and/or a lower rate of delirium in general hospitals compared with other settings. Further research is needed to better characterize the incidence and prevalence of delirium in young people in the hospital setting.

Co-Occurring Catatonia and COVID-19 Diagnoses Among Hospitalized Individuals in 2020: A National Inpatient Sample Analysis

“… 23 , 24 , 25 Among COVID-19 catatonia patients in this sample, diagnoses of acute brain dysfunction were common, with 20.0% also having a diagnosis of metabolic encephalopathy, 13.1% of unspecified encephalopathy, 12.3% of delirium, and 11.5% of toxic encephalopathy, all codes that are used for delirium in prior coding studies. 26 , 27 , 28 This has potential treatment implications, as benzodiazepines can worsen delirium, and antipsychotics, which are often used to manage sequelae of delirium, 29 may worsen catatonia or risk conversion to malignant catatonia. Moreover, delirium itself is associated with increased mortality in hospitalized patients, 30 and so the high rate of mortality in COVID-19 patients may be in part driven by high delirium incidence.…”

Beyond confusion: Embedding psychiatry in delirium research and clinical practice

“…Delirium is common in early as well as later life, but research on its occurrence is limited. Luccarelli et al 5 found in a large national US claims database that about 2% of children's and young people's hospitalisations were associated with delirium. This rate was lower than prospective studies had indicated, but hospitalisations with delirium coded in claims data were nevertheless associated with a seven‐fold higher mortality risk and substantially increased costs.…”