Delirium Screening in Critically Ill Children: Secondary Analysis of the Multicenter PICU Up! Pilot Trial Dataset, 2019

Delirium Screening in Critically Ill Children: Secondary Analysis of the Multicenter PICU Up! Pilot Trial Dataset, 2019–2020

Published:2024-06-04 Issue: Volume: Page:
ISSN:1529-7535
Container-title:Pediatric Critical Care Medicine
language:en
Short-container-title:

Author:

Azamfirei Razvan¹²,Behrens Deanna³,Padilla Sofia³,Madden Kate⁴,Goldberg Sarah⁵,Geno Megan⁶,Manning Mary-Jeanne⁷,Piole Michelle⁸,Madsen Erik⁸,Maue Danielle⁹,Abu-Sultaneh Samer⁹,Awojoodu Ronke¹,Wang Nae-Yuh¹⁰¹¹,Needham Dale M.¹⁰¹¹¹²¹³¹⁴,Neufeld Karin¹⁵,Kudchadkar Sapna R.¹¹³¹⁴¹⁶

Affiliation:

1. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Targu Mures, Romania.

3. Pediatric Critical Care, Advocate Children’s Hospital, Park Ridge, IL.

4. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA.

5. Department of Cardiology, Boston Children’s Hospital, Boston, MA.

6. Department of Physical and Occupational Therapy, Boston Children’s Hospital, Boston, MA.

7. Division of Critical Care Medicine, Boston Children’s Hospital, Boston, MA.

8. Division of Pediatric Critical Care, SSM Health Cardinal Glennon Children’s Hospital, St. Louis, MO.

9. Division of Pediatric Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.

10. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

11. Departments of Biostatistics and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.

12. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

13. Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.

14. Outcomes after Critical Illness and Surgery Group, Johns Hopkins University School of Medicine, Baltimore, MD.

15. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.

16. Department of Pediatrics, Charlotte R. Bloomberg Children’s Center, Johns Hopkins University School of Medicine, Baltimore, MD.

Abstract

Objectives: To determine the patient-level factors associated with performing daily delirium screening in PICUs with established delirium screening practices. Design: A secondary analysis of 2019–2020 prospective data from the baseline phase of the PICU Up! pilot stepped-wedge multicenter trial (NCT03860168). Setting: Six PICUs in the United States. Patients: One thousand sixty-four patients who were admitted to a PICU for 3 or more days. Interventions: None. Measurements and Main Results: Of 1064 patients, 74% (95% CI, 71–76%) underwent delirium screening at least once during their PICU stay. On 57% of the 8965 eligible patient days, screening was conducted. The overall prevalence of delirium was 46% across all screened days, and 64% of screened patients experienced delirium at some point during their PICU stay. Factors associated with greater adjusted odds ratio (aOR) of increased daily delirium screening included PICU stay longer than 15 days compared with 1–3 days (aOR 3.36 [95% CI, 2.62–4.30]), invasive mechanical ventilation as opposed to room air (aOR 1.67 [95% CI, 1.32–2.12]), dexmedetomidine infusions (aOR 1.23 [95% CI, 1.04–1.44]) and propofol infusions (aOR 1.55 [95% CI, 1.08–2.23]). Conversely, decreased aOR of daily delirium screening was associated with female gender (aOR 0.78 [95% CI, 0.63–0.96]), and the administration of continuous infusions of opioids (aOR 0.75 [95% CI, 0.63–0.90]) or ketamine (aOR 0.48 [95% CI, 0.29–0.79]). Neither patient age, the presence of family or physical restraints, or benzodiazepine infusions were associated with daily delirium screening rates. Conclusions: In the 2019–2020 PICU UP! cohort, across six PICUs, delirium screening occurred on only 57% of days, despite the presence of established practices. Female gender, patients in the early stages of their PICU stay, and patients not receiving mechanical ventilation were associated with lower odds of daily delirium screening. Our results highlight the need for structured quality improvement processes to both standardize and increase the frequency of delirium screening.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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