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Improving Delirium Screening in Critically Ill Pediatric Trauma Patients
Christine Perlick1, Amy Vestovich, Dennis W Simon
1Author Affiliations: Department of Pediatric Surgery, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (Ms Perlick); Department of Critical Care Medicine, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (Ms Vestovich, Dr Simon); and Department of Pediatric Surgery, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (Dr Gaines, Dr Richardson, Dr Strotmeyer).
Insights
A delirium intervention improved screening compliance in pediatric trauma patients. Delirium was linked to longer intensive care unit stays and specific discharge needs.
Area of Science:
- Pediatric Critical Care Medicine
- Trauma Surgery
- Neuroscience
Background:
- Delirium is a common complication in critically ill children, associated with adverse outcomes.
- Existing delirium screening protocols are primarily for adults, lacking standardization in pediatric populations.
- Effective delirium management in pediatric trauma requires targeted screening and intervention strategies.
Purpose of the Study:
- To assess the impact of a multicomponent delirium initiative on screening compliance in pediatric trauma patients.
- To identify key risk factors associated with delirium development in this cohort.
- To improve early detection and management of delirium in critically ill children.
Main Methods:
- A pre- and postintervention study design was employed at a Level I pediatric trauma center.
- The Cornell Assessment of Pediatric Delirium tool was used for screening critically ill children (0-18 years) admitted with traumatic injuries.
- Interventions included multidisciplinary education, electronic health record optimization, and feedback audits.
Main Results:
- Delirium screening compliance significantly increased from 20% to 68% postintervention.
- Delirium was diagnosed in 2.7% of patients, with a higher incidence in those with head injuries.
- Delirium correlated with older age, higher Injury Severity Scores, and increased need for blood transfusions.
Conclusions:
- A multicomponent delirium intervention effectively enhanced screening rates in pediatric trauma intensive care units.
- Delirium in pediatric trauma patients is associated with prolonged intensive care unit length of stay and altered discharge disposition.
- Standardized delirium screening and management are crucial for improving outcomes in critically ill pediatric trauma patients.
Background:
Delirium is a complication of the critically ill and is associated with poor outcomes. While delirium screening protocols exist for critically ill adults, standardized screening approaches remain lacking for pediatric patients.
Objective:
This study aims to evaluate a multicomponent delirium initiative's effectiveness in screening compliance and to identify risk factors for delirium in pediatric trauma patients.
Methods:
This pre- and postintervention study was conducted at an urban Level I pediatric trauma center in western Pennsylvania, wherein critically ill children, ages 0 months to 18 years, admitted to the pediatric intensive care unit with traumatic injuries in 2020 and 2021 were screened for delirium using the Cornell Assessment of Pediatric Delirium tool. Interventions included nurse and physician education, screening tool relocation in the electronic health record, delirium score discussions during bedside rounds, and audits with real-time feedback.
Results:
A total of 482 patients were included in the analysis, of which 13 (2.7%) were diagnosed with delirium; 9 (69%) had a head injury. Children with delirium were older, had greater Injury Severity Scores (26 [17-29] vs. 13 [9-21], p = .001), and had a greater likelihood of blood transfusion. Delirium screening compliance increased from 20% preintervention to 68% postintervention. Delirium was associated with increased intensive care unit length of stay and discharge to inpatient rehabilitation.
Conclusion:
This multicomponent delirium intervention in pediatric trauma increased delirium screening rates and found that delirium is associated with increased length of stay and discharge disposition.
