Cited by 379Intensive Care Unit Cognitive DisordersAnesthesia and Sedative AgentsSepsis Diagnosis and Treatment

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Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium

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Traube, Chani, Silver, Gabrielle, Gerber, Linda M., Kaur, Savneet, Mauer, Elizabeth A., Kerson, Abigail, Joyce, Christine, Greenwald, Bruce M.·2017·Critical Care Medicine

DOI 10.1097/ccm.0000000000002324PMC PMC5392157

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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.

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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)
ORCID: Traube, Chani
Silver, Gabrielle
Gerber, Linda M.
Kaur, Savneet
Mauer, Elizabeth A.
Venue: Critical Care Medicine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2017-05
Volume: 45
Issue: 5
Pages: 891-898
ISSN: 0090-3493 (ISSN-L)
DOI: 10.1097/ccm.0000000000002324
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 › Critical Care and Intensive Care Medicine › 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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Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium

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