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Effect of a Delirium Screening Tool on Antipsychotic Medication Use in a Pediatric Intensive Care Unit
Helen Berhane1, Jeffrey Moss2, Eunice Koh3
1Department of Pharmacy (HB), University of California San Diego Medical Center, San Diego, CA.
Insights
Routine screening for pediatric intensive care unit (PICU) delirium did not change antipsychotic prescribing rates. Further research is needed to establish the efficacy of antipsychotics for managing pediatric delirium.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Pharmacology
Background:
- Pediatric intensive care unit (PICU) delirium is linked to adverse outcomes, including longer hospital stays and increased resource use.
- Antipsychotic medications are commonly prescribed for ICU delirium, but evidence supporting their efficacy is limited.
- Delirium screening protocols can lead to pharmacologic or non-pharmacologic interventions.
Purpose of the Study:
- To evaluate the impact of implementing the Cornell Assessment for Pediatric Delirium (CAPD) screening on antipsychotic prescribing rates in a PICU.
- To analyze prescribing patterns and patient characteristics before and after the introduction of delirium screening.
Main Methods:
- A pre- and post-intervention study design was used, comparing antipsychotic prescribing rates before and after January 2019.
- The Cornell Assessment for Pediatric Delirium (CAPD) was implemented for patient screening.
- Data collected included antipsychotic prescribing rates, length of hospital and ICU stay, delirium scores, and time to delirium resolution.
Main Results:
- No significant difference was observed in the overall rate of antipsychotic use between the pre- and post-intervention periods.
- An increase in variability of prescribing rates was noted after the intervention.
- Patients receiving antipsychotics had prolonged hospitalizations (18 days) and ICU stays (14 days) prior to treatment initiation, with high average CAPD scores (16) and multiple elevated scores before treatment.
Conclusions:
- The implementation of delirium screening in the PICU did not alter antipsychotic prescribing frequency.
- Current data suggest antipsychotic use in the PICU occurs late in the course of illness for patients with significant delirium burden.
- Additional research is crucial to determine the actual role and effectiveness of antipsychotic medications in managing pediatric intensive care unit delirium.
Objective:
Intensive care unit (ICU) delirium has been associated with increased length of hospital stay, morbidity, mechanical ventilation, and health care resource utilization. Antipsychotics are frequently used for ICU delirium management, despite a lack of robust evidence in the literature to support their benefit. Delirium screening may result in pharmacologic or non-pharmacologic treatment.
Methods:
In January 2019 we began screening patients admitted to the pediatric ICU (PICU) for delirium using the Cornell Assessment for Pediatric Delirium (CAPD). We compared prescribing rates of antipsychotic medications before and after implementation. We also assessed length of hospital and ICU stay prior to initiating therapy, delirium score prior to initiation of therapy, time after initiation of therapy until score decreased to a level not suggestive of delirium, and continuation of antipsychotics outside of the PICU.
Results:
We did not observe a difference in the rate of antipsychotics use. There was, however, an increase in variability between pre- and post-intervention rates of prescribing. Patients who received an antipsychotic medication were hospitalized for an average of 18 days and in the ICU for 14 days prior to the first dose of an antipsychotic agent. They had an average CAPD score of 16, and had an average of 4 scores above 8 prior to starting treatment.
Conclusion:
This study highlights the need for additional research to demonstrate the role of antipsychotic medications in managing delirium in the PICU.
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