Delirium in Critically Ill Children Common, May Go Undetected

By Megan Brooks

April 06, 2017

NEW YORK (Reuters Health) - About a quarter of children admitted to the intensive care unit (ICU) will develop delirium, according to the first large international study to assess delirium prevalence in critically ill children.

The prevalence of delirium nearly doubles after five days in a pediatric ICU, underscoring the need for routine monitoring of delirium with children, the study found.

Delirium in children in the ICU is “more common and more widespread than previously recognized. Monitoring children for the development of delirium should be a routine part of the care we provide, just as we monitor children for the development of fevers when they are sick,” Dr. Chani Traube, a pediatric intensivist from Weill Cornell Medicine and New York-Presbyterian in New York City, said in a statement.

“We need increased awareness about delirium in children in the ICU in order to detect it early and treat it. It's much easier to treat early delirium than it is to treat delirium that has been entrenched for several days,” she noted in an interview with Reuters Health.

There is a large body of research about delirium in adult ICU patients, but far less in pediatric critical care, Dr. Traube noted.

She and her colleagues did their study at 25 pediatric ICUs in the United States, the Netherlands, New Zealand, Australia and Saudi Arabia. Nurses at these sites screened 994 children for delirium using the Cornell Assessment for Pediatric Delirium (CAPD).

Using this rapid bedside tool, delirium status (delirium vs comatose vs delirium/coma-free) could be established in 835 cases, or 84%, according to the March 14 online report in Critical Care Medicine. Of these, 209 (25%) screened positive for delirium, 13% were classified as comatose, and 62% were delirium-free and coma-free.

The median stay in the pediatric ICU was six days (range two to nine days). Delirium prevalence rates increased markedly after day five in the ICU. For children in the ICU for less than six days, delirium prevalence was 20%. For those who were in the ICU for six or more days, delirium prevalence was 38%, “which was really eye-opening for me,” Dr. Traube told Reuters Health.

The prevalence of delirium varied significantly with reason for ICU stay, with the highest delirium rates (42%) found in children admitted with an infectious or inflammatory disorder, the researchers found. There was no association between delirium and gender, race or ethnicity.

In a multivariate model, factors independently associated with delirium included age younger than 2 years, mechanical ventilation, use of benzodiazepines or narcotics, use of physical restraints, and exposure to vasopressors and antiepileptics.

“There is significant opportunity for improvement in the ICU environment and in our prescribing practices within that initial five day period that might lead to a decrease in the emergence of delirium,” Dr. Traube told Reuters Health.

“There absolutely are children that are higher risk for developing delirium from the get-go; upon admission to the ICU they can be identified and there are ICU practices that further contribute to delirium,” said Dr. Traube.

This study supports the feasibility of using CAPD to screen for delirium in the pediatric ICU, the researchers say.

“Most of the ICUs participating in our study don't routinely screen for delirium, and they were able to do so without much difficulty in nearly all their patients,” Dr. Traube said in a statement. “You don't need to buy expensive equipment or do extensive training.”

The study was supported by the Clinical and Translational Science Center at Weill Cornell Medicine. Dr. Traube has disclosed no potential conflicts of interest.

SOURCE: https://bit.ly/2mNsT1W

Crit Care Med 2017.

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