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Observational Study
. 2020 Dec;48(12):1829-1834.
doi: 10.1097/CCM.0000000000004661.

Association Between Pediatric Delirium and Quality of Life After Discharge

Gabrielle Silver  1 , Hannah Doyle, Emily Hegel, Savneet Kaur, Elizabeth A Mauer, Linda M Gerber, Chani Traube
Affiliations
Observational Study

Association Between Pediatric Delirium and Quality of Life After Discharge

Gabrielle Silver et al. Crit Care Med. 2020 Dec.

Abstract

Objective: Delirium occurs frequently in critically ill children, with highest rates reported in children under 5 years old. The objective of this study was to measure the residual effect of delirium on quality of life at 1 and 3 months after hospital discharge.

Design: Prospective observational cohort study.

Setting: Urban academic PICU.

Patients: Children younger than five years of age at time of admission to the PICU.

Interventions: All children were screened for delirium (using the Cornell Assessment for Pediatric Delirium) throughout their stay in the PICU. Quality of life was measured using the Infant-Toddler Quality of Life questionnaire at three time points: baseline, 1 month, and 3 months after hospital discharge. Infant-Toddler Quality of Life scores were compared between children who did and did not develop delirium.

Measurements and main results: Two hundred seven children were enrolled. One hundred twenty-two completed the 1-month follow-up, and 117 completed the 3-month follow-up. Fifty-six children (27%) developed delirium during their PICU stay. At follow-up, Infant-Toddler Quality of Life scores for the PICU cohort overall were consistently lower than age-related norms. When analyzed by delirium status, children who had experienced delirium scored lower in every quality of life domain when compared with children who did not experience delirium. Even after controlling for severity of illness, delirious patients demonstrated an average 11-point lower general health score than nondelirious patients (p = 0.029).

Conclusion: This pilot study shows an independent association between delirium and decreased quality of life after hospital discharge in young children.

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Figures

Figure 1:
Figure 1:
Quality of life scores were significantly lower at one-month after hospital discharge in the cohort of children who experienced delirium during their stay in the pediatric intensive care unit. (Scores reported as means. Domains as defined by the Infant-Toddler Quality of Life (IT-QOL) Questionnaire: PA=physical abilities; GD=satisfaction with growth and development; BP=bodily pain; TM=temperament and mood; CBE=combined behavior/getting along; GH=general health perceptions; PE=parent impact/emotional; PT=parent impact/time. See text for details).
Figure 2:
Figure 2:
In multivariable analysis, quality of life was significantly lower in most domains for the cohort of children who experienced delirium. (X-axis represents estimates and confidence limits for each domain score at 1-month after discharge, after adjusting for severity of PICU illness. Y-axis represents IT-QOL domains as defined in the text).
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References

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