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Delirium in the Critically Ill Child: Assessment and Sequelae
Rebecca S Paterson1,2, Justin A Kenardy1,3, Alexandra C De Young4
1a School of Psychology , The University of Queensland , Brisbane , Australia.
Insights
Delirium is a serious brain condition in critically ill children, often missed due to assessment challenges. Early detection and intervention are crucial for better outcomes and recovery after pediatric intensive care unit stays.
Area of Science:
- Pediatric critical care medicine
- Neuropsychiatry
- Intensive care
Background:
- Delirium is a common, serious complication in critically ill patients, signaling brain dysfunction.
- Adult delirium research is advancing, but pediatric understanding, especially assessment and outcomes, lags significantly.
- Recognizing delirium symptoms in children, particularly in intensive care settings, presents unique challenges.
Purpose of the Study:
- To address the challenges in assessing delirium in critically ill children.
- To review the current literature on the outcomes of pediatric delirium.
- To emphasize the importance of delirium assessment in determining patient impact.
Main Methods:
- Literature review focusing on pediatric delirium assessment challenges.
- Analysis of existing data on pediatric intensive care unit (PICU) delirium outcomes.
- Discussion of the link between assessment and patient outcomes.
Main Results:
- Delirium assessment in critically ill children is diagnostically challenging for clinicians.
- Pediatric delirium is associated with detrimental effects on recovery post-PICU discharge.
- Caregiver well-being is also impacted by pediatric delirium.
Conclusions:
- Delirium in critically ill children is underrecognized and poses significant challenges.
- Improved assessment strategies are needed to understand and mitigate the negative impacts of pediatric delirium.
- Further research and clinical guidelines are essential for managing delirium in pediatric intensive care settings.
Abstract:
Delirium is a common and serious neuropsychiatric complication in critically ill patients of all ages. In the context of critical illness, delirium may emerge as a result of a cascade of underlying pathophysiologic mechanisms and signals organ failure of the brain. Awareness of the clinical importance of delirium in adults is growing as emerging research demonstrates that delirium represents a serious medical problem with significant sequelae. However, our understanding of delirium in children lags significantly behind the adult literature. In particular, our knowledge of how to assess delirium is complicated by challenges in recognizing symptoms of delirium in pediatric patients especially in critical and intensive care settings, and our understanding of its impact on acute and long-term functioning remains in its infancy. This paper focuses on (a) the challenges associated with assessing delirium in critically ill children, (b) the current literature on the outcomes of delirium including morbidity following discharge from PICU, and care-giver well-being, and (c) the importance of assessment in determining impact of delirium on outcome. Current evidence suggests that delirium is a diagnostic challenge for clinicians and may play a detrimental role in a child's recovery after discharge from the pediatric intensive care unit (PICU). Recommendations are proposed for how our knowledge and assessment of delirium in children could be improved.
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