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Delirium Screening in Critically Ill Children: Secondary Analysis of the Multicenter PICU Up! Pilot Trial Dataset,
Razvan Azamfirei1,2, Deanna Behrens3, Sofia Padilla3
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Delirium screening occurred on only 57% of eligible days in pediatric intensive care units (PICUs), despite established practices. Factors like female gender and shorter stays were linked to lower screening rates, indicating a need for improved quality improvement processes.
Area of Science:
- Critical Care Medicine
- Pediatric Critical Care
- Quality Improvement Science
Background:
- Delirium is a common complication in pediatric intensive care units (PICUs).
- Established practices for delirium screening exist, but adherence and frequency vary.
- Understanding patient-level factors influencing screening is crucial for improving care.
Purpose of the Study:
- To identify patient-specific factors associated with the frequency of daily delirium screening in PICUs.
- To analyze screening rates and delirium prevalence within a large pediatric cohort.
- To inform targeted interventions for enhancing delirium surveillance.
Main Methods:
- Secondary analysis of prospective data from the PICU Up! pilot trial (2019-2020).
- Included 1,064 patients admitted to six US PICUs for 3+ days.
- Examined patient characteristics and their association with daily delirium screening rates.
Main Results:
- Delirium screening occurred on 57% of eligible patient days; 74% of patients were screened at least once.
- Delirium prevalence was 46% on screened days, with 64% of patients experiencing delirium.
- Longer PICU stays (>15 days), mechanical ventilation, dexmedetomidine, and propofol infusions were associated with increased screening.
- Female gender, shorter stays (1-3 days), and opioid/ketamine infusions were associated with decreased screening.
Conclusions:
- Delirium screening rates remain suboptimal (57%) in PICUs despite established protocols.
- Patient factors such as female gender, early PICU stay, and lack of mechanical ventilation correlate with lower screening frequency.
- Structured quality improvement initiatives are necessary to standardize and increase daily delirium screening.
Objectives:
To determine the patient-level factors associated with performing daily delirium screening in PICUs with established delirium screening practices.
Design:
A secondary analysis of 2019-2020 prospective data from the baseline phase of the PICU Up! pilot stepped-wedge multicenter trial (NCT03860168).
Setting:
Six PICUs in the United States.
Patients:
One thousand sixty-four patients who were admitted to a PICU for 3 or more days.
Interventions:
None.
Measurements And Main Results:
Of 1064 patients, 74% (95% CI, 71-76%) underwent delirium screening at least once during their PICU stay. On 57% of the 8965 eligible patient days, screening was conducted. The overall prevalence of delirium was 46% across all screened days, and 64% of screened patients experienced delirium at some point during their PICU stay. Factors associated with greater adjusted odds ratio (aOR) of increased daily delirium screening included PICU stay longer than 15 days compared with 1-3 days (aOR 3.36 [95% CI, 2.62-4.30]), invasive mechanical ventilation as opposed to room air (aOR 1.67 [95% CI, 1.32-2.12]), dexmedetomidine infusions (aOR 1.23 [95% CI, 1.04-1.44]) and propofol infusions (aOR 1.55 [95% CI, 1.08-2.23]). Conversely, decreased aOR of daily delirium screening was associated with female gender (aOR 0.78 [95% CI, 0.63-0.96]), and the administration of continuous infusions of opioids (aOR 0.75 [95% CI, 0.63-0.90]) or ketamine (aOR 0.48 [95% CI, 0.29-0.79]). Neither patient age, the presence of family or physical restraints, or benzodiazepine infusions were associated with daily delirium screening rates.
Conclusions:
In the 2019-2020 PICU UP! cohort, across six PICUs, delirium screening occurred on only 57% of days, despite the presence of established practices. Female gender, patients in the early stages of their PICU stay, and patients not receiving mechanical ventilation were associated with lower odds of daily delirium screening. Our results highlight the need for structured quality improvement processes to both standardize and increase the frequency of delirium screening.
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