Analyzing Incidence and Risk Factors for Delirium in Non-Intensive Care Pediatric Patients

Our study aimed to identify the incidence of delirium in the inpatient setting outside of intensive care and recognize potential risk factors for delirium.

We conducted a single-center retrospective study analyzing patients on general pediatric floors between September 2022 and January 2024 who screened positively using the Cornell Assessment of Pediatric Delirium (CAPD) tool. Delirium diagnosis was attested by a 2-person clinical team based on the DSM-5 criteria using retrospective clinical data. Incidence of delirium was calculated from the patient population with positive CAPD scores. A logistic regression model was used to assess the association between clinical delirium diagnosis and potential clinical risk factors.

Of 245 patients with positive CAPD scores, 83 (33.9%) were deemed to have delirium through retrospective medical record review. Of those 83 patients, only 11 (13.3%) were diagnosed with delirium during their stay. Factors associated with increased odds of delirium included exposure to midazolam, diphenhydramine, hydroxyzine (odds ratios [ORs] of 2.59 [95% CI, 1.47-4.56], 3.4 [95% CI, 1.59-7.30], and 4.3 [95% CI, 1.42-13.0], respectively), diagnosis of sepsis (OR, 3.15; 95% CI, 1.46-6.81), and length of stay (LOS) greater than 5 days (OR, 1.90; 95% CI, 1.11-3.26).

Approximately one-third of patients who screened positive for delirium on the pediatric medical floor had symptoms consistent with delirium. Sepsis, LOS greater than 5 days, and exposures to specific sedatives and antihistamines are risk factors for developing delirium. Future research may focus on improving screening and understanding the role of risk factors in delirium.