DOI: 10.1097/01.ccm.0000457625.37177.77

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Issn Print: 0090-3493

Publication Date: 2014/12/01


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128: PEDIATRIC DELIRIUM PREVALENCE AND MOTORIC SUBTYPES IN CRITICALLY ILL INFANTS AND YOUNG CHILDREN

Christina Goben; Maalobeeka Gangopadhyay; Mary Hamilton Chestnut; Natalie Jacobowski; Catherine Fuchs; E. Wesley Ely; Pratik Pandharipande; Heidi Smith

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Author Information: Vanderbilt Children’s Hospital, Nashville, TN

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Learning Objectives: Advances in delirium research among infants and young children lag behind that in adults due to the lack of valid and developmentally appropriate delirium monitoring tools. The PreSchool Confusion Assessment Method for the ICU (psCAM-ICU) is a bedside delirium tool recently validated against formal neuropsychiatric evaluation, with a sensitivity of 84% and specificity of 91%. The objective of this study was to determine the prevalence and motoric subtypes of delirium in critically ill infants and children.
Methods: We prospectively enrolled critically ill infants and children aged 6 months to 5 years, admitted to the pediatric ICU (PICU). This cohort was part of the psCAM-ICU validation study where enrolled patients were independently assessed for delirium daily by the research team using the psCAM-ICU and the reference standard, consisting of formal neuropsychiatric assessment. The motoric subtype was determined by the concurrent sedation score accompanying a positive delirium assessment.
Results: A total of 631 psCAM-ICU assessments were performed on 242 critically ill patients with a mean age of 22.6 months, 62% male, 77% Caucasian, and 36% admitted for acute respiratory syndrome. Within the cohort 53% required mechanical ventilation. The mean PICU length of stay was 12.9 days. The mortality rate was 4%. Delirium occurred at least once in 100 of 242 (41%) patients. Rates of delirium were 49% in patients ≤2 years and 31% when >2 years. Of the 187 (30%) positive psCAM-ICU delirium assessments, the hypoactive subtype (81%) was more common than the hyperactive subtype (19%). The reference standard rated 31% of their assessments as delirium positive, with only 8% of delirium diagnoses related to drug withdrawal.
Conclusions: Delirium is extremely prevalent among critically ill children. The most common presentation is hypoactive delirium, which is concerning as this subtype is associated with worse outcomes in adults. Further study is necessary to delineate pediatric delirium associated risk factors and outcomes.

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