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Screening for Delirium During Pediatric Brain Injury Rehabilitation
William D Watson1, Hsuan-Wei Chen2, Adrian M Svingos3
1Blythedale Children's Hospital, Valhalla, NY; Department of Rehabilitation & Regenerative Medicine, Columbia University, New York, NY.
Insights
Routine delirium screening using the Cornell Assessment of Pediatric Delirium (CAPD) is feasible in children with acquired brain injury (ABI). Delirium is common, and tracking CAPD scores can predict rehabilitation outcomes.
Area of Science:
- Pediatric Rehabilitation
- Neuroscience
- Critical Care Medicine
Background:
- Delirium is a significant concern in pediatric patients with acquired brain injury (ABI).
- Routine screening for delirium is not standard practice in pediatric rehabilitation settings.
- Understanding delirium prevalence and its impact on recovery is crucial for optimizing care.
Purpose of the Study:
- To evaluate the feasibility of implementing routine delirium screening using the Cornell Assessment of Pediatric Delirium (CAPD) in children with ABI undergoing rehabilitation.
- To determine the prevalence of positive delirium screens in this pediatric population.
- To explore longitudinal trends in CAPD scores and their association with rehabilitation outcomes, such as functional independence.
Main Methods:
- A retrospective study was conducted in a pediatric inpatient rehabilitation unit.
- 144 children with ABI were included, with a median age of 10.8 years.
- Data collected included screening compliance, prevalence of positive CAPD screens, and CAPD score trajectories in relation to functional measures (WeeFIM).
Main Results:
- Delirium screening was feasible, achieving 75% compliance.
- 29% of all screens were positive, with 62% of children experiencing at least one positive screen.
- Four distinct CAPD trajectory patterns were identified, correlating with functional outcomes; younger age was linked to positive screens, and the 'Improving' group had longer stays.
Conclusions:
- Delirium is frequent in children with ABI during inpatient rehabilitation.
- Routine CAPD screening is feasible and provides valuable clinical information for early detection of complications.
- Longitudinal delirium symptom ratings may aid in defining the Post-Traumatic Confusional State (PTCS) in pediatric recovery.
Objective:
To assess feasibility of routine delirium screening using the Cornell Assessment of Pediatric Delirium (CAPD) in children admitted for rehabilitation with acquired brain injury (ABI), report on the prevalence of positive delirium screens in this population, and explore longitudinal trends in CAPD scores and their association with rehabilitation outcomes.
Design:
Retrospective study.
Setting:
Pediatric inpatient rehabilitation unit.
Participants:
144 children (median 10.8 years) with ABI (N=144).
Interventions:
Not applicable.
Main Outcome Measures:
Percent compliance with twice daily delirium screening; prevalence of positive delirium screens; trajectories in CAPD scores and their relation with FIM for Children (WeeFIM) scores.
Results:
Screening was feasible (mean 75% compliance for each of 144 children). Of 16,136 delirium screens, 29% were positive. 62% of children had ≥1 positive screen. Four primary patterns of CAPD trajectories were identified: Static Encephalopathy (10%), Episodic Delirium (10%), Improving (32%), and No Delirium (48%). Validity of these trajectories was demonstrated through association with WeeFIM and CALS outcomes. Younger age at admission was associated with positive delirium screens, and rehabilitation length of stay was significantly longer for the Improving group.
Conclusions:
Delirium occurs frequently in children with ABI during inpatient rehabilitation. Routine delirium screening provides clinically relevant information including the potential to facilitate early detection and intervention for medical complications. Longitudinal ratings of delirium symptoms may also have a role in developing a standardized definition for Post Traumatic Confusional State (PTCS) stage of recovery in children.
