Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May;45(5):891-898.
doi: 10.1097/CCM.0000000000002324.

Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium

Chani Traube  1 , Gabrielle Silver, Linda M Gerber, Savneet Kaur, Elizabeth A Mauer, Abigail Kerson, Christine Joyce, Bruce M Greenwald
Affiliations

Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium

Chani Traube et al. Crit Care Med. 2017 May.

Abstract

Objectives: Delirium occurs frequently in adults and is an independent predictor of mortality. However, the epidemiology and outcomes of pediatric delirium are not well-characterized. The primary objectives of this study were to describe the frequency of delirium in critically ill children, its duration, associated risk factors, and effect on in-hospital outcomes, including mortality. Secondary objectives included determination of delirium subtype, and effect of delirium on duration of mechanical ventilation, and length of hospital stay.

Design: Prospective, longitudinal cohort study.

Setting: Urban academic tertiary care PICU.

Patients: All consecutive admissions from September 2014 through August 2015.

Interventions: Children were screened for delirium twice daily throughout their ICU stay.

Measurements and main results: Of 1,547 consecutive patients, delirium was diagnosed in 267 (17%) and lasted a median of 2 days (interquartile range, 1-5). Seventy-eight percent of children with delirium developed it within the first 3 PICU days. Most cases of delirium were of the hypoactive (46%) and mixed (45%) subtypes; only 8% of delirium episodes were characterized as hyperactive delirium. In multivariable analysis, independent predictors of delirium included age less than or equal to 2 years old, developmental delay, severity of illness, prior coma, mechanical ventilation, and receipt of benzodiazepines and anticholinergics. PICU length of stay was increased in children with delirium (adjusted relative length of stay, 2.3; CI = 2.1-2.5; p < 0.001), as was duration of mechanical ventilation (median, 4 vs 1 d; p < 0.001). Delirium was a strong and independent predictor of mortality (adjusted odds ratio, 4.39; CI = 1.96-9.99; p < 0.001).

Conclusions: Delirium occurs frequently in critically ill children and is independently associated with mortality. Some in-hospital risk factors for delirium development are modifiable. Interventional studies are needed to determine best practices to limit delirium exposure in at-risk children.

PubMed Disclaimer

Conflict of interest statement

Disclosures: All authors have no relevant conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
FIGURE 1a: Duration (in days) of delirium (n=267 patients) FIGURE 1b: Time (in PICU days) to onset of delirium (n=267 patients)
FIGURE 1
FIGURE 1
FIGURE 1a: Duration (in days) of delirium (n=267 patients) FIGURE 1b: Time (in PICU days) to onset of delirium (n=267 patients)
See this image and copyright information in PMC

Comment in

References

    1. Barr J, Fraser GL, Puntillo K, et al. Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Crit Care Med. 2013 Jan;41(1):278–80. - PubMed
    1. Diagnostic and Statistical Manual of Mental Disorders. 5. American Psychiatric Association; 2013.
    1. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Jama. 2004;291(14):1753–1762. - PubMed
    1. Girard TD, Jackson JC, Pandharipande PP, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010 Jul;38(7):1513–20. - PMC - PubMed
    1. Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med. 2001 Dec;27(12):1892–900. - PMC - PubMed

MeSH terms