Chani Traube1, Gabrielle Silver, Linda M Gerber, Savneet Kaur, Elizabeth A Mauer, Abigail Kerson, Christine Joyce, Bruce M Greenwald. 1. 1Department of Pediatrics, Weill Cornell Medical College, New York, NY. 2Department of Psychiatry, Weill Cornell Medical College, New York, NY. 3Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY. 4Weill Cornell Medical College, New York, NY. 5Department of Pediatrics, New York Presbyterian Hospital, New York, NY.
Abstract
OBJECTIVES: Delirium occurs frequently in adults and is an independent predictor of mortality. However, the epidemiology and outcomes of pediatric delirium are not well-characterized. The primary objectives of this study were to describe the frequency of delirium in critically ill children, its duration, associated risk factors, and effect on in-hospital outcomes, including mortality. Secondary objectives included determination of delirium subtype, and effect of delirium on duration of mechanical ventilation, and length of hospital stay. DESIGN: Prospective, longitudinal cohort study. SETTING: Urban academic tertiary care PICU. PATIENTS: All consecutive admissions from September 2014 through August 2015. INTERVENTIONS: Children were screened for delirium twice daily throughout their ICU stay. MEASUREMENTS AND MAIN RESULTS: Of 1,547 consecutive patients, delirium was diagnosed in 267 (17%) and lasted a median of 2 days (interquartile range, 1-5). Seventy-eight percent of children with delirium developed it within the first 3 PICU days. Most cases of delirium were of the hypoactive (46%) and mixed (45%) subtypes; only 8% of delirium episodes were characterized as hyperactive delirium. In multivariable analysis, independent predictors of delirium included age less than or equal to 2 years old, developmental delay, severity of illness, prior coma, mechanical ventilation, and receipt of benzodiazepines and anticholinergics. PICU length of stay was increased in children with delirium (adjusted relative length of stay, 2.3; CI = 2.1-2.5; p < 0.001), as was duration of mechanical ventilation (median, 4 vs 1 d; p < 0.001). Delirium was a strong and independent predictor of mortality (adjusted odds ratio, 4.39; CI = 1.96-9.99; p < 0.001). CONCLUSIONS: Delirium occurs frequently in critically ill children and is independently associated with mortality. Some in-hospital risk factors for delirium development are modifiable. Interventional studies are needed to determine best practices to limit delirium exposure in at-risk children.
OBJECTIVES:Delirium occurs frequently in adults and is an independent predictor of mortality. However, the epidemiology and outcomes of pediatric delirium are not well-characterized. The primary objectives of this study were to describe the frequency of delirium in critically illchildren, its duration, associated risk factors, and effect on in-hospital outcomes, including mortality. Secondary objectives included determination of delirium subtype, and effect of delirium on duration of mechanical ventilation, and length of hospital stay. DESIGN: Prospective, longitudinal cohort study. SETTING: Urban academic tertiary care PICU. PATIENTS: All consecutive admissions from September 2014 through August 2015. INTERVENTIONS:Children were screened for delirium twice daily throughout their ICU stay. MEASUREMENTS AND MAIN RESULTS: Of 1,547 consecutive patients, delirium was diagnosed in 267 (17%) and lasted a median of 2 days (interquartile range, 1-5). Seventy-eight percent of children with delirium developed it within the first 3 PICU days. Most cases of delirium were of the hypoactive (46%) and mixed (45%) subtypes; only 8% of delirium episodes were characterized as hyperactive delirium. In multivariable analysis, independent predictors of delirium included age less than or equal to 2 years old, developmental delay, severity of illness, prior coma, mechanical ventilation, and receipt of benzodiazepines and anticholinergics. PICU length of stay was increased in children with delirium (adjusted relative length of stay, 2.3; CI = 2.1-2.5; p < 0.001), as was duration of mechanical ventilation (median, 4 vs 1 d; p < 0.001). Delirium was a strong and independent predictor of mortality (adjusted odds ratio, 4.39; CI = 1.96-9.99; p < 0.001). CONCLUSIONS:Delirium occurs frequently in critically ill children and is independently associated with mortality. Some in-hospital risk factors for delirium development are modifiable. Interventional studies are needed to determine best practices to limit delirium exposure in at-risk children.
Authors: Timothy D Girard; James C Jackson; Pratik P Pandharipande; Brenda T Pun; Jennifer L Thompson; Ayumi K Shintani; Sharon M Gordon; Angelo E Canonico; Robert S Dittus; Gordon R Bernard; E Wesley Ely Journal: Crit Care Med Date: 2010-07 Impact factor: 7.598
Authors: S K Inouye; S T Bogardus; P A Charpentier; L Leo-Summers; D Acampora; T R Holford; L M Cooney Journal: N Engl J Med Date: 1999-03-04 Impact factor: 91.245
Authors: Pratik P Pandharipande; Brenda T Pun; Daniel L Herr; Mervyn Maze; Timothy D Girard; Russell R Miller; Ayumi K Shintani; Jennifer L Thompson; James C Jackson; Stephen A Deppen; Renee A Stiles; Robert S Dittus; Gordon R Bernard; E Wesley Ely Journal: JAMA Date: 2007-12-12 Impact factor: 56.272
Authors: Juliana Barr; Gilles L Fraser; Kathleen Puntillo; E Wesley Ely; Céline Gélinas; Joseph F Dasta; Judy E Davidson; John W Devlin; John P Kress; Aaron M Joffe; Douglas B Coursin; Daniel L Herr; Avery Tung; Bryce R H Robinson; Dorrie K Fontaine; Michael A Ramsay; Richard R Riker; Curtis N Sessler; Brenda Pun; Yoanna Skrobik; Roman Jaeschke Journal: Crit Care Med Date: 2013-01 Impact factor: 7.598
Authors: Chani Traube; Elizabeth A Mauer; Linda M Gerber; Savneet Kaur; Christine Joyce; Abigail Kerson; Charlene Carlo; Daniel Notterman; Stefan Worgall; Gabrielle Silver; Bruce M Greenwald Journal: Crit Care Med Date: 2016-12 Impact factor: 7.598
Authors: Jan N M Schieveld; Piet L J M Leroy; Jim van Os; Joost Nicolai; Gijs D Vos; Albert F G Leentjens Journal: Intensive Care Med Date: 2007-04-25 Impact factor: 17.440
Authors: Cydni N Williams; Mary E Hartman; Kristin P Guilliams; Rejean M Guerriero; Juan A Piantino; Christopher C Bosworth; Skyler S Leonard; Kathryn Bradbury; Amanda Wagner; Trevor A Hall Journal: Curr Treat Options Neurol Date: 2019-09-27 Impact factor: 3.598
Authors: Sapna R Kudchadkar; Othman Aljohani; Jordan Johns; Andrew Leroux; Eman Alsafi; Ebaa Jastaniah; Allan Gottschalk; Nehal J Shata; Ahmad Al-Harbi; Daniel Gergen; Anisha Nadkarni; Ciprian Crainiceanu Journal: J Pediatr Date: 2019-03-15 Impact factor: 4.406
Authors: Venu Amula; David F Vener; Charles G Pribble; Lori Riegger; Elizabeth C Wilson; Lara S Shekerdemian; Zhining Ou; Angela P Presson; Madolin K Witte; Susan C Nicolson Journal: Pediatr Crit Care Med Date: 2019-10 Impact factor: 3.624
Authors: Mary E Hartman; Cydni N Williams; Trevor A Hall; Christopher C Bosworth; Juan A Piantino Journal: Pediatr Neurol Date: 2020-02-20 Impact factor: 3.372
Authors: Kalgi Mody; Savneet Kaur; Elizabeth A Mauer; Linda M Gerber; Bruce M Greenwald; Gabrielle Silver; Chani Traube Journal: Crit Care Med Date: 2018-09 Impact factor: 7.598