Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium
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 durat...
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| Veröffentlicht in: | Critical care medicine 2017-05, Vol.45 (5), p.891-898 |
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| creator | Traube, Chani Silver, Gabrielle Gerber, Linda M. Kaur, Savneet Mauer, Elizabeth A. Kerson, Abigail Joyce, Christine Greenwald, Bruce M. |
| description | 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. |
| doi_str_mv | 10.1097/CCM.0000000000002324 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5392157</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>28288026</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5354-d007da487b119fb780e18c7028b789fd209ebdae4fe90a9e31f88e54d602c31a3</originalsourceid><addsrcrecordid>eNqFkF1P2zAUhq1paHSFfzBN_gMpxx9p7F1MmkJhSEXlYru2nPiEenPiykmp-u8JdCDGBViyfCy_z2vpIeQLgxkDXZyV5fUMXiwuuPxAJiwXkAHX4iOZAGjIhNTimHzu-z8ATOaF-ESOueJKAZ9PSHWOwSe_bantHL2OabDBD3vqO1omP_jahrCnVyHQcu2DS9h9o4uNd9j6GOLt_hFbbYc6ttjT2NAbdN4Oydf0qfmEHDU29Hj675yS3xeLX-XPbLm6vCp_LLM6F7nMHEDhrFRFxZhuqkIBMlUXwNU468Zx0Fg5i7JBDVajYI1SmEs3B14LZsWUfD_0brZVi67Gbkg2mE3yrU17E603_790fm1u453JheZsFDMl8lBQp9j3CZtnloF5cG5G5-a18xH7-vLfZ-hJ8hhQh8AuhgFT_zdsd5jMGm0Y1u91yzfQh9iYmmccWAH5eMvGzbS4B_Z8nzw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium</title><source>MEDLINE</source><source>Journals@Ovid Ovid Autoload</source><creator>Traube, Chani ; Silver, Gabrielle ; Gerber, Linda M. ; Kaur, Savneet ; Mauer, Elizabeth A. ; Kerson, Abigail ; Joyce, Christine ; Greenwald, Bruce M.</creator><creatorcontrib>Traube, Chani ; Silver, Gabrielle ; Gerber, Linda M. ; Kaur, Savneet ; Mauer, Elizabeth A. ; Kerson, Abigail ; Joyce, Christine ; Greenwald, Bruce M.</creatorcontrib><description>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.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0000000000002324</identifier><identifier>PMID: 28288026</identifier><language>eng</language><publisher>United States: by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</publisher><subject>Academic Medical Centers - statistics & numerical data ; Adolescent ; Age Factors ; Child ; Child, Preschool ; Critical Illness - epidemiology ; Critical Illness - mortality ; Delirium - diagnosis ; Delirium - mortality ; Developmental Disabilities - epidemiology ; Female ; Hospital Mortality ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Pediatric - statistics & numerical data ; Length of Stay - statistics & numerical data ; Longitudinal Studies ; Male ; Prospective Studies ; Respiration, Artificial ; Risk Factors ; Severity of Illness Index ; Time Factors</subject><ispartof>Critical care medicine, 2017-05, Vol.45 (5), p.891-898</ispartof><rights>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.</rights><rights>Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5354-d007da487b119fb780e18c7028b789fd209ebdae4fe90a9e31f88e54d602c31a3</citedby><cites>FETCH-LOGICAL-c5354-d007da487b119fb780e18c7028b789fd209ebdae4fe90a9e31f88e54d602c31a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28288026$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Traube, Chani</creatorcontrib><creatorcontrib>Silver, Gabrielle</creatorcontrib><creatorcontrib>Gerber, Linda M.</creatorcontrib><creatorcontrib>Kaur, Savneet</creatorcontrib><creatorcontrib>Mauer, Elizabeth A.</creatorcontrib><creatorcontrib>Kerson, Abigail</creatorcontrib><creatorcontrib>Joyce, Christine</creatorcontrib><creatorcontrib>Greenwald, Bruce M.</creatorcontrib><title>Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>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.</description><subject>Academic Medical Centers - statistics & numerical data</subject><subject>Adolescent</subject><subject>Age Factors</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Critical Illness - epidemiology</subject><subject>Critical Illness - mortality</subject><subject>Delirium - diagnosis</subject><subject>Delirium - mortality</subject><subject>Developmental Disabilities - epidemiology</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Intensive Care Units, Pediatric - statistics & numerical data</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Prospective Studies</subject><subject>Respiration, Artificial</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Time Factors</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkF1P2zAUhq1paHSFfzBN_gMpxx9p7F1MmkJhSEXlYru2nPiEenPiykmp-u8JdCDGBViyfCy_z2vpIeQLgxkDXZyV5fUMXiwuuPxAJiwXkAHX4iOZAGjIhNTimHzu-z8ATOaF-ESOueJKAZ9PSHWOwSe_bantHL2OabDBD3vqO1omP_jahrCnVyHQcu2DS9h9o4uNd9j6GOLt_hFbbYc6ttjT2NAbdN4Oydf0qfmEHDU29Hj675yS3xeLX-XPbLm6vCp_LLM6F7nMHEDhrFRFxZhuqkIBMlUXwNU468Zx0Fg5i7JBDVajYI1SmEs3B14LZsWUfD_0brZVi67Gbkg2mE3yrU17E603_790fm1u453JheZsFDMl8lBQp9j3CZtnloF5cG5G5-a18xH7-vLfZ-hJ8hhQh8AuhgFT_zdsd5jMGm0Y1u91yzfQh9iYmmccWAH5eMvGzbS4B_Z8nzw</recordid><startdate>20170501</startdate><enddate>20170501</enddate><creator>Traube, Chani</creator><creator>Silver, Gabrielle</creator><creator>Gerber, Linda M.</creator><creator>Kaur, Savneet</creator><creator>Mauer, Elizabeth A.</creator><creator>Kerson, Abigail</creator><creator>Joyce, Christine</creator><creator>Greenwald, Bruce M.</creator><general>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</general><general>Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20170501</creationdate><title>Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium</title><author>Traube, Chani ; Silver, Gabrielle ; Gerber, Linda M. ; Kaur, Savneet ; Mauer, Elizabeth A. ; Kerson, Abigail ; Joyce, Christine ; Greenwald, Bruce M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5354-d007da487b119fb780e18c7028b789fd209ebdae4fe90a9e31f88e54d602c31a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Academic Medical Centers - statistics & numerical data</topic><topic>Adolescent</topic><topic>Age Factors</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Critical Illness - epidemiology</topic><topic>Critical Illness - mortality</topic><topic>Delirium - diagnosis</topic><topic>Delirium - mortality</topic><topic>Developmental Disabilities - epidemiology</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Intensive Care Units, Pediatric - statistics & numerical data</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Prospective Studies</topic><topic>Respiration, Artificial</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Traube, Chani</creatorcontrib><creatorcontrib>Silver, Gabrielle</creatorcontrib><creatorcontrib>Gerber, Linda M.</creatorcontrib><creatorcontrib>Kaur, Savneet</creatorcontrib><creatorcontrib>Mauer, Elizabeth A.</creatorcontrib><creatorcontrib>Kerson, Abigail</creatorcontrib><creatorcontrib>Joyce, Christine</creatorcontrib><creatorcontrib>Greenwald, Bruce M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Traube, Chani</au><au>Silver, Gabrielle</au><au>Gerber, Linda M.</au><au>Kaur, Savneet</au><au>Mauer, Elizabeth A.</au><au>Kerson, Abigail</au><au>Joyce, Christine</au><au>Greenwald, Bruce M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2017-05-01</date><risdate>2017</risdate><volume>45</volume><issue>5</issue><spage>891</spage><epage>898</epage><pages>891-898</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><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.</abstract><cop>United States</cop><pub>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</pub><pmid>28288026</pmid><doi>10.1097/CCM.0000000000002324</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Academic Medical Centers - statistics & numerical data Adolescent Age Factors Child Child, Preschool Critical Illness - epidemiology Critical Illness - mortality Delirium - diagnosis Delirium - mortality Developmental Disabilities - epidemiology Female Hospital Mortality Humans Infant Infant, Newborn Intensive Care Units, Pediatric - statistics & numerical data Length of Stay - statistics & numerical data Longitudinal Studies Male Prospective Studies Respiration, Artificial Risk Factors Severity of Illness Index Time Factors |
| title | Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium |
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