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Delirium documentation in hospitalized pediatric patients with cancer
Kelly Lastrapes1, Malisa Dang2, J Brian Cassel2
1Pediatric Hematology, Oncology and Palliative Care, Department of Pediatrics, Division of Pediatric Hematology/Oncology, Virginia Commonwealth University, Richmond, VA, USA.
Insights
Delirium is often not documented or coded correctly in pediatric cancer patients. Universal screening tools could improve the identification and management of delirium in these vulnerable children.
Area of Science:
- Pediatric critical care
- Pediatric oncology
- Hematology/Oncology
Background:
- Delirium screening is increasing in pediatric critical care but remains inconsistent.
- Underdiagnosis, misdiagnosis, and underdocumentation of delirium are significant concerns in hospitalized children.
- This study focuses on identifying and documenting delirium in pediatric oncology and bone marrow transplant patients.
Purpose of the Study:
- To evaluate the identification and documentation of delirium in hospitalized pediatric oncology and bone marrow transplant patients.
- To assess the accuracy of delirium coding and physician documentation compared to chart review.
- To highlight the need for improved delirium detection in this patient population.
Main Methods:
- Retrospective chart review of pediatric oncology and bone marrow transplant patients (aged <21) admitted between 2013-2016.
- Exclusion criteria included major psychiatric conditions, developmental delays, or autism.
- Data collection focused on documentation of delirium identification and diagnosis.
Main Results:
- Delirium was documented in 54 of 201 (26.9%) hospitalizations from 109 unique patients.
- The overall documented incidence was 3.2% of hospitalizations or 8.2% of unique patients.
- Opioid and benzodiazepine use correlated with delirium documentation; ICD coding under-reported delirium, and physician documentation was inaccurate in 26% of cases.
Conclusions:
- Delirium is frequently undocumented or miscoded in pediatric oncology and bone marrow transplant patients.
- Current documentation and coding practices are insufficient for accurate delirium identification.
- Implementing validated, universal delirium screening tools is recommended to improve detection and clinical outcomes.
Objective:
Screening tools for delirium are being used more consistently in pediatric critical care. However, screening is not universal, and delirium may be underdiagnosed, misdiagnosed, or undocumented in hospitalized patients. We evaluated the identification and documentation of delirium in pediatric oncology and bone marrow transplant patients.
Method:
A retrospective chart review on all hospitalized pediatric oncology and bone marrow transplant patients admitted to an Academic Cancer center between 2013 and 2016. Patients aged less than 21 years of age with active cancer were included. Patients with major psychiatric conditions, developmental delays, or autism were excluded. Data were collected to characterize documentation concerning the identification and diagnosis of delirium.
Results:
Of 201 hospitalization records, 54 (26.9%) admissions from 109 unique patients had documentation of delirium. The overall documented incidence of delirium was 3.2% of hospitalizations or 8.2% of unique patients. Patients prescribed opioids and benzodiazepines were more likely to have documentation of delirium. ICD coding under-reported delirium while physician documentation was inaccurate in 26% (53/201) when compared with the chart review.
Significance Of Results:
Delirium was frequently undocumented or miscoded. Implementing a validated, universal screening tool for delirium may improve identification and clinical outcomes.
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