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Delirium in a Tertiary Pediatric Cardiac Intensive Care Unit: Risk Factors and Outcomes
Andrew M Koth1,2, Titus Chan1,2,3, Yuen Lie Tjoeng1,2
1Division of Pediatric Critical Care Medicine, 271845Department of Pediatrics, University of Washington, Seattle, WA, USA.
Insights
Delirium is common in pediatric cardiac intensive care units (CICU), with younger age, mechanical ventilation, and sedative use increasing risk. Longer delirium screening positive duration correlates with extended hospital stays.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Hospital epidemiology
Background:
- Delirium is a frequent complication in pediatric cardiac intensive care units (CICU).
- It is associated with adverse outcomes in critically ill children.
- Identifying risk factors and outcomes is crucial for improving patient care.
Purpose of the Study:
- To identify risk factors for delirium screening positivity in pediatric CICU patients.
- To examine the association between the duration of positive delirium screening and in-hospital outcomes.
Main Methods:
- Retrospective cohort study of 942 children admitted to a pediatric cardiac intensive care unit (CICU) between March 2014 and October 2016.
- Used the Cornell Assessment of Pediatric Delirium for screening.
- Employed multivariable logistic and linear regression for statistical analysis.
Main Results:
- 67% of patients screened positive for delirium.
- Independent risk factors for positive screening included younger age (<2 years), mechanical ventilation duration, and higher doses of benzodiazepines and opioids.
- Longer duration of positive delirium screening was linked to increased CICU and hospital length of stay.
Conclusions:
- Delirium screening positivity is prevalent in the pediatric CICU and associated with longer hospitalizations.
- Reducing mechanical ventilation duration and sedative exposure may mitigate delirium burden.
- Further research into delirium prevention strategies in this vulnerable population is warranted.
Objective:
Delirium is an increasingly recognized hospital complication associated with poorer outcomes in critically ill children. We aimed to evaluate risk factors for screening positive for delirium in children admitted to a pediatric cardiac intensive care unit (CICU) and to examine the association between duration of positive screening and in-hospital outcomes.
Study Design:
Retrospective cohort study in a single-center quaternary pediatric hospital CICU evaluating children admitted from March 2014-October 2016 and screened for delirium using the Cornell Assessment of Pediatric Delirium. Statistical analysis used multivariable logistic and linear regression.
Results:
Among 942 patients with screening data (98% of all admissions), 67% of patients screened positive for delirium. On univariate analysis, screening positive was associated with younger age, single ventricle anatomy, duration of mechanical ventilation, continuous renal replacement therapy, extracorporeal life support, and surgical complexity, as well as higher average total daily doses of benzodiazepines, opioids, and dexmedetomidine. On multivariable analysis, screening positive for delirium was independently associated with age <2 years, duration of mechanical ventilation, and greater than the median daily doses of benzodiazepine and opioid. In addition to these factors, duration of screening positive was also independently associated with higher STAT category (3-5) or medical admission, organ failure, acute kidney injury (AKI), and higher dexmedetomidine exposure. Duration of positive delirium screening was associated with both increased CICU and hospital length of stay (each additional day of positive screening was associated with a 3% longer CICU stay [95% CI = 1%-6%] and 2% longer hospital stay [95% CI = 0%-4%]).
Conclusions:
Screening positive for delirium is common in the pediatric CICU and is independently associated with prolonged intensive care unit (ICU) and hospital stay. Longer duration of mechanical ventilation and higher sedative doses are independent risk factors for screening positive for delirium. Efforts aimed at reducing these exposures may decrease the burden of delirium in this population.
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