Delirium in Children Undergoing Hematopoietic Cell Transplantation: A Multi-Institutional Point Prevalence Study

Area of Science:

• Pediatric Hematology/Oncology
• Pediatric Critical Care
• Neuroscience

Background:

• Delirium is a frequent complication in adult hematopoietic cell transplant (HCT) recipients, associated with significant morbidity.
• The prevalence and risk factors for delirium in pediatric HCT patients during the peri-transplant period are not well understood.
• Establishing feasibility of multi-institutional bedside screening is crucial for understanding and managing pediatric delirium.

Purpose of the Study:

• To determine the rates of delirium in children undergoing HCT.
• To identify demographic and treatment-related risk factors for delirium in this population.
• To assess the feasibility of multi-institutional bedside screening for pediatric delirium.

Main Methods:

• A multi-institutional point prevalence study involving 11 North American centers.
• Prospective daily screening for delirium using the Cornell Assessment of Pediatric Delirium (CAP-D) over a 10-day period.
• Extraction of de-identified demographic and clinical data from electronic medical records.

Main Results:

• 45% of 106 enrolled children developed delirium during the 10-day study period.
• The overall daily delirium rate was 18%, with higher rates in children younger than 5 years.
• Medications associated with increased delirium risk included melatonin, steroids, and tacrolimus.

Conclusions:

• Delirium is a frequent complication in pediatric HCT recipients, with identifiable risk factors.
• Bedside delirium screening is highly feasible in this patient population.
• Further large-scale longitudinal studies are needed to fully characterize pediatric delirium epidemiology and guide prevention/treatment strategies.