Family Presence at the PICU Bedside and Pediatric Patient Delirium: Retrospective Analysis of a Single-Center Cohort, 2014-2017
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Mallory B Smith1, Elizabeth Y Killien2,3, R Scott Watson2,3
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
Insights
Increased family presence in the pediatric intensive care unit (PICU) is linked to reduced odds of pediatric delirium. This finding highlights family presence as a potentially modifiable factor to alleviate delirium burden in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Psychology
Background:
- Pediatric delirium is a common complication in the pediatric intensive care unit (PICU).
- Delirium can negatively impact patient outcomes and increase healthcare costs.
- Understanding modifiable factors that influence delirium risk is crucial for improving patient care.
Purpose of the Study:
- To investigate the association between family presence at the bedside and the occurrence of positive delirium screening scores in pediatric intensive care unit patients.
- To determine if family presence is a protective factor against pediatric delirium.
Main Methods:
- Retrospective cohort study conducted at a tertiary children's hospital PICU.
- Included children under 18 with PICU stays longer than 36 hours from 2014-2017.
- Assessed delirium using the Cornell Assessment of Pediatric Delirium (CAP-PD) twice daily; family presence documented every 2 hours.
Main Results:
- 55% of patients experienced positive delirium screening on 44% of PICU days.
- Greater family presence (≥90%) was associated with a lower proportion of patients ever screened positive for delirium.
- Increased family presence correlated with lower odds of same-day and subsequent-day positive delirium screening, even after adjusting for baseline severity (PCPC).
Conclusions:
- Higher family presence at the PICU bedside is associated with reduced odds of pediatric delirium.
- Family presence represents a potentially modifiable intervention to decrease the incidence and impact of delirium in critically ill children.
- Further research is recommended to explore barriers and facilitators to maximizing family presence in the PICU setting.
Objectives:
To examine the association between family presence at the PICU bedside and daily positive delirium screening scores.
Design:
Retrospective cohort study.
Setting:
Tertiary children's hospital PICU.
Subjects:
Children younger than 18 years old with PICU length of stay greater than 36 hours enrolled in the Seattle Children's Hospital Outcomes Assessment Program from 2014 to 2017.
Interventions:
None.
Measurements And Main Results:
In the dataset, delirium screening had been performed bid using the Cornell Assessment of Pediatric Delirium, with scores greater than or equal to 9 classified as positive. Family presence was documented every 2 hours. Among 224 patients, 55% ( n = 124/224) had positive delirium screening on 44% ( n = 408/930) of PICU days. Family presence at the bedside during PICU stay (< 90% compared with ≥ 90%) was associated with higher proportion of ever (as opposed to never) being screened positive for delirium (26/37 vs. 98/187; difference, 17.9% [95% CI, 0.4-32.1%]; p = 0.046). On univariate analysis, each additional decile of increasing family presence was associated with lower odds of positive delirium screening on the same day (odds ratio [OR], 0.87 [95% CI, 0.77-0.97]) and subsequent day (OR, 0.84 [95% CI, 0.75-0.94]). On multivariable analysis after adjustments, including baseline Pediatric Cerebral Performance Category (PCPC), higher family presence was associated with lower odds of subsequent-day positive delirium screening (OR, 0.89 [95% CI, 0.81-0.98]). Among patients with PCPC less than or equal to 2, each additional decile of increasing family presence was independently associated with lower odds of both same-day (OR, 0.90 [95% CI, 0.81-0.99]) and subsequent-day (OR, 0.85 [95% CI, 0.76-0.95]) positive delirium screening.
Conclusions:
In our 2014-2017 retrospective cohort, greater family presence was associated with lower odds of delirium in PICU patients. Family presence is a modifiable factor that may mitigate the burden of pediatric delirium, and future studies should explore barriers and facilitators of family presence in the PICU.
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