Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium
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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.
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Even after accounting for illness severity, delirium is associated with increased short- and long-term morbidity, leading to higher healthcare resource utilization and expenditure, and mortality.
“Even after accounting for illness severity, delirium is associated with increased short- and long-term morbidity, leading to higher healthcare resource utilization and expenditure, and mortality [7,61,64,65,66].”
From Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness (2022) · cites this paper as [66]
The Results (‘Effect on In-Hospital Outcomes’; page not provided) associate pediatric delirium with longer PICU stays and higher in-hospital mortality after adjustment for illness severity. The Introduction mentions long-term disability and a separate analysis of hospital costs, but this study does not establish long-term morbidity or increased expenditure. Its Limitations also caution that the observed associations do not establish causality. (LLM, conf=0.88)
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Delirium and Developmental Disability: Improving Specificity of a Pediatric Delirium Screen*
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Implementation of a Delirium Bundle for Pediatric Intensive Care Patients
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Delirium in Hospitalized Children with Cancer: Incidence and Associated Risk Factors
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Development of a non‐pharmacologic delirium management bundle in paediatric intensive care units
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Pain and Sedation Management: 2018 Update for the Rogers’ Textbook of Pediatric Intensive Care
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Day-Night Activity in Hospitalized Children after Major Surgery: An Analysis of 2,271 Hospital DaysPreprint
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Outcomes following admission to paediatric intensive care: A systematic review
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Delirium Knowledge, Self-Confidence, and Attitude in Pediatric Intensive Care Nurses
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Assessment and Management of Delirium in the Pediatric Intensive Care Unit: A Review
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State of the science in pediatric ICU delirium: An integrative review
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Brain Injury in Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach
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Sleep and Delirium in Pediatric Critical Illness: What Is the Relationship?
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Delirium in the Critically Ill Child: Assessment and Sequelae
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The ICU Liberation Bundle and Strategies for Implementation in Pediatrics
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Antipsychotic Treatment of Delirium in Critically Ill Children: A Retrospective Matched Cohort Study
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Delirium in the NICU: A Point Prevalence Study
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Cognitive and Behavioral Consequences of Pediatric Delirium: A Pilot Study*
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Modified ABCDEF-Bundles for Critically Ill Pediatric Patients - What Could They Look Like?
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Neurologic Outcomes Following Care in the Pediatric Intensive Care Unit
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Brighter Days May Be Ahead: Continuous Measurement of Pediatric Intensive Care Unit Light and Sound
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Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness
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Delirium in a Tertiary Pediatric Cardiac Intensive Care Unit: Risk Factors and Outcomes
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Patterns of Delirium in a Pediatric Intensive Care Unit and Associations With Noise Pollution
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The Validity and Reliability of the Japanese Version of the Cornell Assessment of Pediatric Delirium
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Pediatric Delirium in the Cardiac Intensive Care Unit: Identification and Intervention
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Opioid Use Is Associated with ICU Delirium in Mechanically Ventilated Children
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Development and validation of a postoperative delirium prediction model for pediatric patients
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Sedation strategies in children with pediatric acute respiratory distress syndrome (PARDS)
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Delirium in the Critically Ill Child
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Pediatric Delirium and All-Cause PICU Readmissions Within 1 Year*
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Beware the Aftermath: Delirium and Post-Intensive Care Syndrome in Critically Ill Children*
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Characterizing Sleep Disruption and Delirium in Children After Cardiac Surgery: A Feasibility Study
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“The Times They Are A-Changin”: Universal Delirium Screening in Pediatric Critical Care*
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Factors associated with Pediatric Delirium in the Pediatric Intensive Care Unit
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Risk factors of delirium in a paediatric intensive care unit: A prospective case series study
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- Authors
- Traube, C., Silver, G., Gerber, L. M., Kaur, S., Mauer, E. A., Kerson, A., Joyce, C., & Greenwald, B. M.
- Affiliations
- Weill Cornell Medicine (US)
- NewYork–Presbyterian Hospital (US)
- Venue
- Critical Care Medicine
- Published
- 2017-05
- Volume
- 45
- Issue
- 5
- Pages
- 891-898
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC5392157
- OpenAlex
- W2593019651
- Cited by
- 379
- References
- 53
- Citations by year
- 2026: 36 · 2025: 41 · 2024: 37 · 2023: 48 · 2022: 45 · 2021: 54 · 2020: 42 · 2019: 31 · 2018: 28 · 2017: 15
- FWCI
- 29.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000457)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- pediatric delirium, critically ill children, mortality, hypoactive delirium, hyperactive delirium, risk factors, mechanical ventilation duration, length of hospital stay, benzodiazepines, anticholinergic agents, developmental delay, intensive care unit
- MeSH terms
- Academic Medical Centers, Adolescent, Age Factors, Child, Developmental Disabilities, Child, Preschool, Delirium, Female, Humans, Infant, Infant, Newborn, Length of Stay, Longitudinal Studies, Male, Prospective Studies, Respiration, Artificial, Risk Factors, Severity of Illness Index, Time Factors, Intensive Care Units, Pediatric, Critical Illness, Hospital Mortality
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