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Effect of Neurologic Conditions on Delirium Duration and Time to ICU Discharge

Kate J Frost1, Heidi Chen2, Zackary Schoonover3

  • 1Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA.

Critical Care Explorations
|January 26, 2026
PubMed

Insights

Children with baseline developmental delay (DD) experience longer delirium and lower ICU discharge rates. Delirium partially mediates these outcomes, highlighting the need to mitigate DD

Area of Science:

  • Pediatric Critical Care Medicine
  • Pediatric Neurology
  • Neuroscience

Background:

  • Delirium is common in critically ill children and linked to poor outcomes.
  • Understanding risk factors and mediators is crucial for improving care.

Purpose of the Study:

  • To investigate if baseline developmental delay (DD) or acute neurologic conditions (ANC) increase delirium duration or delay ICU discharge.
  • To determine if delirium mediates the association between DD/ANC and outcomes.

Main Methods:

  • Post hoc analysis of a prospective, observational study.
  • Included children aged 6 months to 5 years admitted to a tertiary pediatric intensive care unit (PICU).
  • Daily delirium assessment using the Pediatric Confusion Assessment Method for the ICU (PEDs CAM-ICU).

Main Results:

  • Developmental delay (DD) was associated with significantly longer delirium duration (p=0.008) and lower likelihood of ICU discharge (HR 0.76).
  • Acute neurologic conditions (ANC) showed a trend towards longer delirium duration (p=0.056) and lower ICU discharge likelihood (HR 0.73).
  • Delirium partially mediated the relationship between DD and ICU discharge, and potentially between ANC and ICU discharge.

Conclusions:

  • Baseline developmental delay in critically ill children predicts longer delirium and reduced ICU discharge rates.
  • Delirium acts as a mediator in the association between developmental delay and adverse outcomes.
  • Further research on mitigating the impact of developmental delay on delirium and outcomes in critically ill children is essential.
Abstract

Keywords:
ICU outcomesacute brain dysfunctionbrain injurycomadeliriumdevelopmental delayneurologic intensive care unit

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