Delirium in critically ill children common, may go undetected

(Reuters Health) - About a quarter of children admitted to the intensive care unit (ICU) will develop delirium, according to the first large international study to assess how common the condition is in critically ill children.

The prevalence of delirium nearly doubles after five days in a pediatric ICU, underscoring the need for routine monitoring of children for it, researchers say.

“(The condition) is more common and more widespread than previously recognized,” Dr. Chani Traube, a pediatric intensivist from Weill Cornell Medicine and New York-Presbyterian in New York City, said in a statement. “Monitoring children for the development of delirium should be a routine part of the care we provide, just as we monitor children for the development of fevers when they are sick.”

“We need increased awareness about delirium in children in the ICU in order to detect it early and treat it. It’s much easier to treat early delirium than it is to treat delirium that has been entrenched for several days,” Traube noted in an interview with Reuters Health.

There is a large body of research about delirium in adult ICU patients, but far less in pediatric critical care, she said.

Traube and her colleagues did their study at 25 pediatric ICUs in the United States, the Netherlands, New Zealand, Australia and Saudi Arabia. Nurses at these sites screened 994 children for delirium with a test called the Cornell Assessment for Pediatric Delirium (CAPD).

Using this rapid bedside tool, delirium status could be established in 835 cases, or 84 percent, according to the results in Critical Care Medicine. Of the children whose status could be determined, 209 screened positive for delirium, 13 percent were classified as comatose and 62 percent were delirium-free and coma-free.

The duration of children’s stays in the pediatric ICU ranged from two to nine days, with an average of six.

Delirium rates increased markedly after day five in the ICU, the study found. For children in the ICU for less than six days, 20 percent experienced delirium. For those who were in the ICU for six or more days, delirium prevalence was 38 percent, “which was really eye-opening for me,” Traube said.

The prevalence of delirium varied significantly with reason for ICU stay, with the highest delirium rates (42 percent) found in children admitted with an infectious or inflammatory disorder.

Other factors independently associated with delirium included age younger than 2 years, mechanical ventilation, use of benzodiazepines or narcotics, use of physical restraints and exposure to blood pressure or antiepileptic drugs.

“There is significant opportunity for improvement in the ICU environment and in our prescribing practices within that initial five day period that might lead to a decrease in the emergence of delirium,” Traube said.

“There absolutely are children that are higher risk for developing delirium from the get-go; upon admission to the ICU they can be identified and there are ICU practices that further contribute to delirium,” she said.

This study supports the feasibility of using CAPD to screen for delirium in the pediatric ICU, the researchers conclude in their report.

“Most of the ICUs participating in our study don’t routinely screen for delirium, and they were able to do so without much difficulty in nearly all their patients,” Traube said in her statement. “You don’t need to buy expensive equipment or do extensive training.”

SOURCE: Critical Care Medicine, online March 10, 2017.

This story has been refiled to change slug.