Cheryl Holly1, Sallie Porter, Mercedes Echevarria, Margaret Dreker, Sevara Ruzehaji. 1. Cheryl Holly is a professor, senior methodologist, and codirector of the Northeast Institute for Evidence Synthesis and Translation at Rutgers School of Nursing, Newark, NJ, where Sallie Porter is an assistant professor and Margaret Dreker is a research librarian. Mercedes Echevarria is an associate professor at George Washington University, Washington, DC, and Sevara Ruzehaji is a staff nurse at Englewood Hospital, Englewood, NJ; at the time of this writing, Echevarria was an associate professor in the Advanced Practice Division at Rutgers School of Nursing, where Ruzehaji was an honors student. Funding from the Society of Pediatric Nurses partially supported the research reported in this study. Contact author: Cheryl Holly, hollych@sn.rutgers.edu. The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.
Abstract
: Purpose: The purpose of this study was to examine the evidence regarding the risk factors for and characteristics of acute pediatric delirium in hospitalized children. METHODS: The systematic review method within an epidemiological framework of person, place, and time was used. Fifty-two studies were selected for initial retrieval. Of these, after assessment for methodological quality, 21 studies involving 2,616 subjects were included in the review. RESULTS: Findings revealed five primary characteristics seen in children experiencing delirium: agitation, disorientation, hallucinations, inattention, and sleep-wake cycle disturbances. Children who were more seriously ill, such as those in a pediatric ICU (PICU) and those with a high Pediatric Risk of Mortality II (PRISM II) score, and children who were mechanically ventilated were at greater risk for development of delirium. Those with a developmental delay or a preexisting anxiety disorder were also more prone to delirium. Although delirium symptoms fluctuate, most episodes occurred at night. Boys were slightly more susceptible than girls, though this difference was not significant. A key finding of this review was that delirium is multifactorial, related to treatment (mechanical ventilation, for example) and to a hospital environment (such as a PICU) that deprives patients of normal sleep-wake cycles and familiar routines. CONCLUSION: These findings will be useful in efforts to achieve earlier recognition and better management or prevention of pediatric delirium. This may also help to prevent unnecessary laboratory testing and imaging studies, which can cause children and parents unnecessary pain and anxiety and increase hospital costs.
: Purpose: The purpose of this study was to examine the evidence regarding the risk factors for and characteristics of acute pediatric delirium in hospitalized children. METHODS: The systematic review method within an epidemiological framework of person, place, and time was used. Fifty-two studies were selected for initial retrieval. Of these, after assessment for methodological quality, 21 studies involving 2,616 subjects were included in the review. RESULTS: Findings revealed five primary characteristics seen in children experiencing delirium: agitation, disorientation, hallucinations, inattention, and sleep-wake cycle disturbances. Children who were more seriously ill, such as those in a pediatric ICU (PICU) and those with a high Pediatric Risk of Mortality II (PRISM II) score, and children who were mechanically ventilated were at greater risk for development of delirium. Those with a developmental delay or a preexisting anxiety disorder were also more prone to delirium. Although delirium symptoms fluctuate, most episodes occurred at night. Boys were slightly more susceptible than girls, though this difference was not significant. A key finding of this review was that delirium is multifactorial, related to treatment (mechanical ventilation, for example) and to a hospital environment (such as a PICU) that deprives patients of normal sleep-wake cycles and familiar routines. CONCLUSION: These findings will be useful in efforts to achieve earlier recognition and better management or prevention of pediatric delirium. This may also help to prevent unnecessary laboratory testing and imaging studies, which can cause children and parents unnecessary pain and anxiety and increase hospital costs.