Variations in analgesic, sedation, and delirium management between trauma and non-trauma critically ill children

Area of Science:

• Pediatric critical care medicine
• Pharmacology
• Health services research

Background:

• Intensive care unit (ICU) protocols are often based on medical patients, potentially overlooking differences in surgical and trauma populations.
• Critically ill pediatric patients present unique challenges and may have distinct medication profiles.

Purpose of the Study:

• To investigate and compare the medication profiles of critically ill pediatric medical, surgical, and trauma patients.
• To identify differences in the administration of analgesics, sedatives, and other key medications among these distinct patient groups.

Main Methods:

• Retrospective cohort study using the Pediatric Health Information System 2017 dataset.
• Categorized patients into medical, surgical, and trauma cohorts based on ICD-10 codes.
• Analyzed demographics, diagnoses, outcomes, and medication data (opiates, GABA-agonists, etc.) for the first 30 ICU days using Kolmogorov-Smirnov tests and odds ratios.

Main Results:

• The trauma cohort showed higher incidences of delirium and mortality compared to medical and surgical cohorts.
• GABA-agonists were administered to over 50% of patients across all cohorts within the first 30 ICU days.
• Significant differences in the administration of opiates, GABA-agonists, alpha-2 agonists, anti-psychotics, and other sedatives were observed between cohorts. Trauma patients had higher odds of receiving anti-psychotics.

Conclusions:

• Critically ill pediatric patients in medical, surgical, and trauma categories represent distinct populations.
• Pharmacologic profiles for analgesia, sedation, and delirium management differ significantly among these pediatric ICU patient groups.
• This highlights the need for specialized, evidence-based treatment protocols tailored to the specific needs of pediatric trauma, surgical, and medical patients.