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Delirium in Critically Ill Children: An International Point Prevalence Study*

Traube, Chani MD; Silver, Gabrielle MD; Reeder, Ron W. PhD; Doyle, Hannah BS; Hegel, Emily MPH; Wolfe, Heather A. MD; Schneller, Christopher MD; Chung, Melissa G. MD; Dervan, Leslie A. MD, MS; DiGennaro, Jane L. MD, MS; Buttram, Sandra D. W. MD; Kudchadkar, Sapna R. MD; Madden, Kate MD, MMSc; Hartman, Mary E. MD, MPH; deAlmeida, Mary L. MD; Walson, Karen MD; Ista, Erwin RN, PhD; Baarslag, Manuel A MD; Salonia, Rosanne MD; Beca, John FCICM, MBChB; Long, Debbie BNurs, MNurs, PhD; Kawai, Yu MD; Cheifetz, Ira M. MD; Gelvez, Javier MD; Truemper, Edward J. MD; Smith, Rebecca L. MD; Peters, Megan E. MD; O’Meara, AM Iqbal MD; Murphy, Sarah MD; Bokhary, Abdulmohsen MD; Greenwald, Bruce M. MD; Bell, Michael J. MD

doi: 10.1097/CCM.0000000000002250
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Objectives: To determine prevalence of delirium in critically ill children and explore associated risk factors.

Design: Multi-institutional point prevalence study.

Setting: Twenty-five pediatric critical care units in the United States, the Netherlands, New Zealand, Australia, and Saudi Arabia.

Patients: All children admitted to the pediatric critical care units on designated study days (n = 994).

Intervention: Children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the bedside nurse. Demographic and treatment-related variables were collected.

Measurements and Main Results: Primary study outcome measure was prevalence of delirium. In 159 children, a final determination of mental status could not be ascertained. Of the 835 remaining subjects, 25% screened positive for delirium, 13% were classified as comatose, and 62% were delirium-free and coma-free. Delirium prevalence rates varied significantly with reason for ICU admission, with highest delirium rates found in children admitted with an infectious or inflammatory disorder. For children who were in the PICU for 6 or more days, delirium prevalence rate was 38%. In a multivariate model, risk factors independently associated with development of delirium included age less than 2 years, mechanical ventilation, benzodiazepines, narcotics, use of physical restraints, and exposure to vasopressors and antiepileptics.

Conclusions: Delirium is a prevalent complication of critical illness in children, with identifiable risk factors. Further multi-institutional, longitudinal studies are required to investigate effect of delirium on long-term outcomes and possible preventive and treatment measures. Universal delirium screening is practical and can be implemented in pediatric critical care units.

1Weill Cornell Medical College, New York, NY.

2University of Utah, Salt Lake City, UT.

3The Children’s Hospital of Philadelphia, Philadelphia, PA.

4Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.

5Nationwide Children’s Hospital, Columbus, OH.

6University of Washington, Seattle, WA.

7University of Arizona College of Medicine, Phoenix, AZ.

8Johns Hopkins University School of Medicine, Baltimore, MD.

9Boston Children’s Hospital, Boston, MA.

10Washington University in St. Louis, St. Louis, MO.

11Emory University School of Medicine, Atlanta, GA.

12Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA.

13Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.

14Connecticut Children’s Medical Center, Hartford, CT.

15Starship Children’s Hospital, Auckland, New Zealand.

16Lady Cilento Children’s Hospital, Brisbane, Australia.

17C.S. Mott Children’s Hospital, Ann Arbor, MI.

18Duke Children’s Hospital, Durham, NC.

19Cook Children’s Hospital, Fort Worth, TX.

20Children’s Hospital and Medical Center, Omaha, NE.

21University of North Carolina, Chapel Hill, NC.

22University of Wisconsin, Madison, WI.

23Virginia Commonwealth University, Richmond, VA.

24Massachusetts General Hospital, Boston, MA.

25Al Hada Armed Forces Hospital, Taif, Saudi Arabia.

26University of Pittsburgh, Pittsburgh, PA.

*See also p. 746.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by Weill Cornell Medical College Clinical and Translational Science Center (CTSC Grant UL1 TR000457) for REDCap and research coordination to collect, manage, analyze, and interpret the data.

Dr. DiGennaro received funding from salary/employment (She was employed full time as a pediatric intensivist at Seattle Children’s Hospital with an academic appointment through the University of Washington), speaking fees (She was invited to speak at the American Association of Critical Care Nurses [Portland, Oregon] annual conference in 2013. Her hotel was paid for by the AACN, and she additionally received $600 to offset the cost of travel and meals), and from a grant (She received a grant for $50,000 from Seattle Children’s Hospital Academic Enrichment Fund for a pilot randomized trial of acupuncture as an adjunct to pharmacologic sedation in mechanically ventilated children). Dr. Cheifetz received funding from Philips and from Ikaria (both unrelated to the topic of the current article). Dr. Truemper’s institution received funding from Gerber Foundation (through University of Nebraska, Lincoln). Dr. O’Meara received funding from Virginia Commonwealth University (salary and internal research grant). Dr. Greenwald received funding from various law firms and insurance companies for expert testimony. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Chani Traube, MD, Weill Cornell Medical College, Division of Pediatric Critical Care Medicine, 525 East 68th Street M-508, New York, NY 10065. E-mail: Chr9008@med.cornell.edu

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