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Meta-Analysis
. 2023 May 1;24(5):372-381.
doi: 10.1097/PCC.0000000000003196. Epub 2023 Feb 15.

Factors Associated With Delirium in Children: A Systematic Review and Meta-Analysis

Erwin Ista  1   2 , Chani Traube  3 , Marjorie de Neef  4 , Jan Schieveld  5   6   7 , Hennie Knoester  4 , Marja Molag  8 , Sapna R Kudchadkar  9   10   11 , Jacqueline Strik  5   6   7 ; Dutch Multidisciplinary Pediatric Delirium Guideline Group
Affiliations
Meta-Analysis

Factors Associated With Delirium in Children: A Systematic Review and Meta-Analysis

Erwin Ista et al. Pediatr Crit Care Med. .

Abstract

Objectives: Pediatric delirium (PD) is a neuropsychiatric syndrome caused by a complex interplay between predisposing factors (e.g., age, cognitive impairment), acute illness, and environmental triggers. PD is associated with substantial morbidity and mortality. The objective of this study is to systematically review and evaluate factors associated with PD in hospitalized pediatric patients.

Data sources: A systematic search of PubMed, Embase, Ovid Medline, Web- of-Science, Cochrane, CIHNAL, and Google Scholar databases was conducted for relevant studies (1990-2022).

Study selection: We included studies that compared pediatric patients with and without delirium. Reviews, editorials, congress abstracts, or studies that did not report factors for PD were excluded. No restrictions were imposed on language.

Data extraction: Title and abstract were independently screened by two reviewers. Individual characteristics, study design, and outcomes were independently extracted.

Data synthesis: Categorical dichotomous data were summarized across groups using Mantel-Haenszel odds ratios (ORs) with 95% 95% CIs. Either fixed-effect or random effects models were used as indicated by the results of a heterogeneity test. Of 1,846 abstracts, 24 studies were included. We identified 54 factors studied in univariate analyses, and 27 of these were associated with PD in multivariable analyses. In pooled analyses, greater odds of PD were associated with developmental delay (OR 3.98; 95% CI 1.54-10.26), need for mechanical ventilation (OR 6.02; 95% CI 4.43-8.19), use of physical restraints (OR 4.67; 95% CI 1.82-11.96), and receipt of either benzodiazepines (OR 4.10; 95% CI 2.48-6.80), opiates (OR 2.88; 95% CI 1.89-4.37), steroids (OR 2.02; 95% CI 1.47-2.77), or vasoactive medication (OR 3.68; 95% CI 1.17-11.60).

Conclusions: In this meta-analysis, we identified seven factors associated with greater odds of developing delirium during pediatric critical illness.

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Conflict of interest statement

Dr. Traube received support for article research from the National Institutes of Health (National Cancer Institute and National Institute of Child Health and Human Development). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA Flow Diagram
Figure 2
Figure 2
Forest plot Benzodiazepines, comparing subgroups PCICU - pediatric cardiac intensive care unit; PICU - pediatric intensive care unit; Ped Onco - pediatric oncology
Figure 3:
Figure 3:
Forest plot Opioids, comparing subgroups PCICU - pediatric cardiac intensive care unit; PICU - pediatric intensive care unit; Ped Onco - pediatric oncology
See this image and copyright information in PMC

Comment in

  • Delirium: The Next Vital Sign in the PICU?
    Lim JKB, Marimuttu VJ, Lee JH. Lim JKB, et al. Pediatr Crit Care Med. 2023 May 1;24(5):422-425. doi: 10.1097/PCC.0000000000003226. Epub 2023 May 4. Pediatr Crit Care Med. 2023. PMID: 37140333 No abstract available.

References

    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fith Edition (DSM-5). Washington, DC: American Psychiatric Association; 2013.
    1. Meyfroidt G, Smith M. Focus on delirium, sedation and neuro critical care 2019: towards a more brain-friendly environment? Intensive Care Med 2019;45(9):1292–1294. - PubMed
    1. Stenkjaer RL, Herling SF, Egerod I, et al. Development of a non-pharmacologic delirium management bundle in paediatric intensive care units. Nurs Crit Care 2022;27(6):867–876. - PMC - PubMed
    1. Semple D, Howlett MM, Strawbridge JD, et al. A Systematic Review and Pooled Prevalence of Delirium in Critically Ill Children. Crit Care Med 2022;50(2):317–328. - PubMed
    1. Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness. N Engl J Med 2013;369(14):1306–1316. - PMC - PubMed

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