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Patterns of Delirium in a Pediatric Intensive Care Unit and Associations With Noise Pollution
Jeffrey R Weatherhead1,2, Matthew Niedner2, Mary K Dahmer2
1Division of Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, 4352Mayo Clinic, Rochester, Minnesota, USA.
Insights
Noise pollution in Pediatric Intensive Care Units (PICUs) is linked to delirium. This study found a moderate correlation between nighttime noise levels and pediatric delirium scores, suggesting noise may be a risk factor.
Area of Science:
- Pediatric Critical Care Medicine
- Environmental Health
- Quality Improvement
Background:
- Delirium is a prevalent issue in Pediatric Intensive Care Units (PICUs), associated with adverse outcomes such as increased length of stay, costs, and mortality.
- Noise pollution is a recognized environmental stressor in healthcare settings, but its specific impact on pediatric delirium requires further investigation.
Purpose of the Study:
- To evaluate the relationship between noise pollution levels and the risk of delirium in patients admitted to a Pediatric Intensive Care Unit (PICU).
- To identify potential environmental factors contributing to delirium development in critically ill children.
Main Methods:
- A Quality Improvement (QI) initiative was conducted in an academic PICU over 83 weeks (2015-2017).
- Continuous sound level monitoring (decibel measurements) and regular screening for delirium using the Cornell Assessment of Pediatric Delirium (CAPD) were performed.
- Data analysis focused on correlations between noise levels (hourly, daily, seasonal) and CAPD scores, as well as risk of mortality (ROM).
Main Results:
- A significant proportion of patients (45.9%) screened positive for delirium (CAPD score ≥ 9).
- Occupied PICU rooms were consistently louder than unoccupied rooms, and daytime noise levels exceeded nighttime levels.
- A moderate positive correlation was observed between median weekly nighttime noise levels and CAPD scores (r=0.6, p<0.001), and a weaker correlation with risk of mortality (r=0.15, p<0.01).
Conclusions:
- The study confirms substantial noise pollution within the PICU environment.
- Nighttime noise levels show a moderate correlation with pediatric delirium scores, suggesting noise pollution may be a contributing risk factor for delirium development.
- Findings support the need for noise reduction strategies in PICUs to potentially mitigate delirium and improve patient outcomes.
Abstract:
Objective: Delirium is a common problem in the Pediatric Intensive Care Unit (PICU) and is associated with increased length of stay, cost and mortality. This study evaluated the relationship between noise pollution and delirium risk. Design: This is a Quality Improvement (QI) initiative at an academic PICU. Sound levels were monitored and patients were screened for delirium using the Cornell Assessment of Pediatric Delirium (CAPD). Setting PICU Patients: All PICU patients Interventions: None Measurements and Main Results: Over the 83-week study period (2015-2017), the median [IQR] CAPD score was 8 [3 to 14]. Nursing compliance with the CAPD was 72.2%. The proportion of patients screening positive for delirium (CAPD ≥ 9) was 45.9%. A total of 329 711 hly decibel (dB) measurements were collected and reported. Occupied rooms were louder than unoccupied rooms (51.8 [51.6-51.9] dB vs. 49.8 [49.7-49.9] dB, respectively, p < 0.001). Days (10 AM to 4 PM) were louder than nights (11 PM to 5 AM) (52.8 [52.7-53.0] dB vs. 50.7 [49.9-51.5] dB, respectively p < 0.001) in occupied rooms. Winter (Nov-Feb) months were louder than summer (May-Aug) months (52.0 [51.8-52.3] dB vs. 51.5 [51.3-51.7] dB, respectively, p < 0.002) in occupied rooms. Median weekly nighttime noise levels and CAPD scores demonstrated a correlation coefficient of 0.6 (p < 0.001). Median weekly risk of mortality (ROM) and CAPD scores demonstrated a correlation coefficient of 0.15 (p < 0.01). Conclusions: Significant noise pollution exists in the PICU with a moderate correlation between nighttime noise levels and CAPD scores. This could potentially implicate noise pollution as a risk factor for the development of delirium.
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