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Risk factors of delirium in paediatric intensive care units: A meta-analysis
Xuelian Zhu1, Xiaoyan Feng2, Jia Lin3
1Department of Orthopedics, Wuxi Children's Hospital, Wuxi, China.
Insights
Delirium in the paediatric intensive care unit (PICU) is linked to developmental delay, mechanical ventilation, and certain medications. Age and length of stay also increase delirium risk in children.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Pharmacology
Background:
- Delirium, a syndrome of brain dysfunction, affects children at a higher incidence.
- Studies on pediatric intensive care unit (PICU) delirium report varying risk factors.
- This study aims to clarify these risk factors for better delirium management in PICU.
Purpose of the Study:
- To systematically review and integrate the identified risk factors for delirium in children within the pediatric intensive care unit.
- To provide a clearer understanding of factors contributing to delirium in this vulnerable population.
Main Methods:
- Comprehensive literature search across multiple databases (CNKI, CBMdisc, Wanfang, VIP, PubMed, Embase, Cochrane, JBI, PsycInfo).
- Inclusion of studies based on the PICOS principle for patients in PICU.
- Data analysis using RevMan 5.3 and Stata, with evidence quality assessed by the GRADE system.
Main Results:
- Ten studies involving 4343 children were analyzed.
- Significant risk factors identified include developmental delay (OR=3.34), mechanical ventilation (OR=4.11), benzodiazepine use (OR=5.05), and anticholinergic use (OR=5.04).
- Older age groups (2-5 and 5-13 years) showed lower delirium incidence compared to younger children, while longer PICU length of stay (OR=1.10) increased risk.
Conclusions:
- Developmental delay, mechanical ventilation, benzodiazepine and anticholinergic use, age, and PICU length of stay are independent risk factors for pediatric delirium.
- The study acknowledges limitations due to the small number of included articles, suggesting potential bias.
- Further large-scale, multicenter studies are recommended to validate these findings and guide clinical practice.
Background:
Delirium is a brain dysfunction syndrome, which children have a higher incidence. At present, there have been more and more studies and reports on delirium in paediatric intensive care unit, but there are some differences in the risk factor results among different studies. To better manage delirium, this study was performed.
Objective:
To integrate and clarify the risk factors for delirium in paediatric intensive care unit.
Methods:
CNKI, CBMdisc, Wanfang Data Knowledge Service Platform, VIP, PubMed, Embase, Cochrane Library, JBI and PsycInfo were searched for relevant literature. The study subjects were patients in PICU and literature was included according to the PICOS principle. Literature screening and risk of bias assessment were mainly completed by two researchers, and RevMan 5.3 software and Stata software were used for data analysis. The GRADE systerm was used to assess the quality of evidence.
Results:
A total of 10 studies were included, all in English, involving 4343 children. Within the GRADE system, 4 indicators were scored A, 1 indicators were scored B, and 3 indicators were scored C regarding evidence levels. Three studies analysed the influence of developmental delay on the occurrence of delirium in PICU, total sample size of which was 1823, and the results showed that the combined effect was statistically significant [OR = 3.34, 95%CI(2.46-4.53), Z = 7.75, P<0.001]; Five studies analysed the effects of mechanical ventilation on the occurrence of delirium in PICU, sample size of which was 1562, and the results showed that the combined effect was statistically significant [OR = 4.11, 95%CI(3.13-5.40), Z = 10.16, P<0.001]; Two studies analysed the effects of benzodiazepines on children developing delirium, sample size of which was 1635, and the results showed that the combined effect was statistically significant [OR = 5.05, 95%CI(3.65-6.97), Z = 9.83, P<0.001]; Two studies analysed the effects of anticholinergic drug use on children developing delirium in PICU, sample size of which was 1703, and the results suggested the combined effect was statistically significant [OR = 5.04, 95%CI (3.62-7.00), Z = 9.63, P<0.001]; Two studies compared the same age period, sample size of which was 1724 and the results showed that children 2-5 years old has a 48% incidence rate of delirium relative to children younger than 2 years old, and the combined effect was statistically significant [OR = 0.48, 95%CI(0.25-0.92), Z = 2.22, P = 0.030], children 5-13 years old has a 39% incidence rate of delirium relative to children younger than 2 years old, and the combined effect was statistically significant [OR = 0.39, 95%CI(0.26-0.59), Z = 4.43, P<0.001]. Two studies analysed the effects of PICU LOS on children developing delirium and the combined effect of PICU LOS on the occurrence of delirium in children in PICU was statistically significant [OR = 1.10, 95%CI(1.05-1.15), Z = 4.07, P<0.001].
Conclusion:
Developmental delay, mechanical ventilation, benzodiazepine use, anticholinergic use, age and PICU length of stay are independent risk factors for delirium in children in PICU. However, only a few articles were included in this study, which may lead to a certain bias and affect the analysing results. More large-sample, multicentre studies should be conducted to further explore and clarify the independent influencing factors of delirium in children in PICU and to provide guidance for clinical practice.
