Delirium in Critically Ill Children: An International Point Prevalence Study

Abstract

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.

Figure 1. Determination of mental status (n=835)

Delirium defined as CAPD score ≥9. Coma defined as subject unarousable to verbal stimulation. 159 children with developmental delay were excluded from this analysis as the bedside nurse could not establish alteration from neurologic baseline.

Figure 2. Delirium rate by ICU day

Percentages are based on assessable subjects who were not comatose (n=723). Study days were collapsed to ensure that at least 50 subjects were in each group to prevent an arbitrary variation in delirium rate.