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Factors Associated With Delirium in Children: A Systematic Review and Meta-Analysis
Erwin Ista1,2, Chani Traube3, Marjorie de Neef4
1Pediatric Intensive Care Unit, Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Insights
Pediatric delirium is linked to developmental delay, mechanical ventilation, physical restraints, and certain medications. Identifying these factors can help reduce the incidence of delirium in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Neuropsychiatry
- Evidence-based medicine
Background:
- Pediatric delirium (PD) is a significant cause of morbidity and mortality in hospitalized children.
- Understanding factors associated with PD is crucial for improving patient outcomes.
- This study systematically reviews and evaluates factors linked to PD in pediatric patients.
Approach:
- A comprehensive systematic search of multiple databases (PubMed, Embase, Web-of-Science, etc.) was performed for studies published between 1990 and 2022.
- Included studies compared pediatric patients with and without delirium, excluding reviews and non-factor reporting studies.
- Data extraction and screening were conducted independently by two reviewers, with meta-analysis used for data synthesis.
Key Points:
- Twenty-four studies were included, analyzing 54 factors in univariate and 27 in multivariable analyses.
- Factors significantly associated with increased odds of PD included developmental delay (OR 3.98), mechanical ventilation (OR 6.02), and physical restraints (OR 4.67).
- Medications such as benzodiazepines (OR 4.10), opiates (OR 2.88), steroids (OR 2.02), and vasoactive agents (OR 3.68) were also associated with higher PD odds.
Conclusions:
- Seven key factors were identified as being associated with a greater likelihood of developing delirium in critically ill children.
- These findings highlight specific risk factors that clinicians can target to prevent or mitigate pediatric delirium.
- Further research can focus on interventions addressing these identified factors to improve care for pediatric patients.
Objectives:
Pediatric delirium (PD) is a neuropsychiatric syndrome caused by a complex interplay between predisposing factors (e.g., age, cognitive impairment), acute illness, and environmental triggers. PD is associated with substantial morbidity and mortality. The objective of this study is to systematically review and evaluate factors associated with PD in hospitalized pediatric patients.
Data Sources:
A systematic search of PubMed, Embase, Ovid Medline, Web- of-Science, Cochrane, CIHNAL, and Google Scholar databases was conducted for relevant studies (1990-2022).
Study Selection:
We included studies that compared pediatric patients with and without delirium. Reviews, editorials, congress abstracts, or studies that did not report factors for PD were excluded. No restrictions were imposed on language.
Data Extraction:
Title and abstract were independently screened by two reviewers. Individual characteristics, study design, and outcomes were independently extracted.
Data Synthesis:
Categorical dichotomous data were summarized across groups using Mantel-Haenszel odds ratios (ORs) with 95% 95% CIs. Either fixed-effect or random effects models were used as indicated by the results of a heterogeneity test. Of 1,846 abstracts, 24 studies were included. We identified 54 factors studied in univariate analyses, and 27 of these were associated with PD in multivariable analyses. In pooled analyses, greater odds of PD were associated with developmental delay (OR 3.98; 95% CI 1.54-10.26), need for mechanical ventilation (OR 6.02; 95% CI 4.43-8.19), use of physical restraints (OR 4.67; 95% CI 1.82-11.96), and receipt of either benzodiazepines (OR 4.10; 95% CI 2.48-6.80), opiates (OR 2.88; 95% CI 1.89-4.37), steroids (OR 2.02; 95% CI 1.47-2.77), or vasoactive medication (OR 3.68; 95% CI 1.17-11.60).
Conclusions:
In this meta-analysis, we identified seven factors associated with greater odds of developing delirium during pediatric critical illness.
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