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Delirium in a Tertiary PICU: Risk Factors and Outcomes
Leslie A Dervan1,2, Jane L Di Gennaro1,2, Reid W D Farris1,2
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
Insights
Pediatric intensive care unit (PICU) delirium is common, especially in longer stays, and linked to benzodiazepine use. Delirium impacts ICU and hospital length of stay and cognitive function, but not mortality.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Hospital epidemiology
Background:
- Delirium is a significant concern in pediatric intensive care units (PICUs).
- Understanding risk factors and outcomes is crucial for improving patient care.
Purpose of the Study:
- To identify risk factors and patient outcomes associated with delirium in pediatric intensive care unit (PICU) patients.
- To investigate the relationship between delirium and factors such as benzodiazepine use and length of mechanical ventilation.
Main Methods:
- A retrospective cohort study was conducted involving 2,446 children admitted to a tertiary care academic children's hospital PICU.
- The Cornell Assessment of Pediatric Delirium score was used to identify delirium, with multivariable logistic and linear regression models applied to electronic medical records data.
Main Results:
- Delirium was more prevalent in patients with a length of stay greater than or equal to 48 hours (69%) compared to shorter stays (30%).
- Independent risk factors for delirium included age less than 2 years, baseline cognitive dysfunction, primary diagnosis, and duration of mechanical ventilation.
- Benzodiazepine use showed a dose-response effect on delirium presence. Delirium was associated with increased ICU and hospital length of stay and cognitive decline, but not mortality.
Conclusions:
- Delirium is frequent in PICU patients, particularly those with longer stays, and is associated with specific patient characteristics and exposures like benzodiazepines.
- While delirium impacts length of stay and cognitive function, its role as an independent causal factor in patient outcomes warrants further research.
Objectives:
To determine risk factors and outcomes associated with delirium in PICU patients.
Design:
Retrospective cohort study.
Setting:
Thirty-two-bed PICU within a tertiary care academic children's hospital.
Patients:
All children admitted to the PICU March 1, 2014, to October 1, 2016, with at least one Cornell Assessment of Pediatric Delirium score (n = 2,446).
Interventions:
None.
Measurements And Main Results:
Cornell Assessment of Pediatric Delirium score was performed twice daily as standard of care. We characterized delirium as: 1) presence of greater than or equal to 1 positive score (Cornell Assessment of Pediatric Delirium ≥ 9) and 2) number of days with a positive score. We built multivariable logistic and linear regression models using electronic medical records data. Many patients (n = 1,538; 63%) had a short length of stay (< 48 hr). Compared with patients with length of stay greater than or equal to 48 hours, fewer experienced delirium (30% vs 69%; p < 0.0001). Among 908 patients with length of stay greater than or equal to 48 hours, presence of delirium was independently associated with age less than 2 years old, baseline cognitive dysfunction, primary diagnosis, and duration of mechanical ventilation. Benzodiazepines demonstrated a dose-response effect (odds ratio for presence of delirium, 1.8 [p = 0.03], 3.4 [p < 0.001], and 9.7 [p = 0.005] for < 25th percentile, 25-75th percentile, and > 75th percentile of total dose, vs no exposure). In terms of outcomes, presence of delirium was independently associated with increased ICU length of stay (p < 0.001), whereas days of delirium were independently associated with decline in cognitive function from ICU admission to discharge (odds ratio, 1.06; p < 0.001), increased ICU (p < 0.001), and hospital length of stay (p < 0.001). Neither delirium presence nor total days were independently associated with mortality.
Conclusions:
Delirium is common in the PICU, particularly among patients with length of stay greater than or equal to 48 hours. It is independently associated with patient characteristics and PICU exposures, including benzodiazepines. The role of delirium as an independent causal factor in patient outcome requires further investigation.
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