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A systematic review and pooled prevalence of delirium in critically ill children
Objectives: Pediatric delirium is a neuropsychiatric disorder with disrupted cerebral functioning due to underlying disease and/or critical care treatment. Pediatric delirium can be classified as hypoactive, hyperactive, and mixed. This systematic review was conducted to estimate the pooled prevalence of pediatric delirium using validated assessment tools in children (Cornell Assessment of Pediatric Delirium, Pediatric Confusion Assessment Method for the ICU, PreSchool Confusion Assessment Method for the ICU, Pediatric Confusion Assessment Method for the ICU Severity Scale, and Sophia Observation Withdrawal Symptoms Pediatric Delirium scale), identify modifiable and nonmodifiable risk factors, and explore the association of pediatric delirium with clinical outcomes.
Data sources: A systematic search of PubMed, EMBASE, and CINAHL databases was undertaken for full articles pertaining to pediatric delirium prevalence.
Study selection: No language or date barriers were set. Studies were included where the following eligibility criteria were met: study design aimed to estimate pediatric delirium prevalence arising from treatment in the intensive care setting, using a validated tool. Only randomized controlled trials, cross-sectional studies, or cohort studies allowing an estimate of the prevalence of pediatric delirium were included.
Data extraction: Data were extracted by the primary researcher (D.S.) and accuracy checked by coauthors.
Data synthesis: A narrative synthesis and pooled prevalence meta-analysis were undertaken.
Conclusions: Pediatric delirium, as determined by the Cornell Assessment of Pediatric Delirium score, is estimated to occur in 34% of critical care admissions. Eight of 11 studies reporting on subtype identified hypoactive delirium as most prevalent (46-81%) with each of the three remaining reporting either hyperactive (44%), mixed (57%), or equal percentages of hypoactive and mixed delirium (43%) as most prevalent. The development of pediatric delirium is associated with cumulative doses of benzodiazepines, opioids, the number of sedative classes used, deep sedation, and cardiothoracic surgery. Increased time mechanically ventilated, length of stay, mortality, healthcare costs, and associations with decreased quality of life after discharge were also found. Multi-institutional and longitudinal studies are required to better determine the natural history, true prevalence, long-term outcomes, management strategies, and financial implications of pediatric delirium.
RSCI School of Pharmacy and Biomolecular Sciences
CommentsThis is a pre-copyedited, author-produced version of an article accepted for publication in Critical Care Medicine. The published version of record Semple D, Howlett MM, Strawbridge JD, Breatnach CV, Hayden JC. A systematic review and pooled prevalence of delirium in critically ill children. Crit Care Med. 2022 Feb 1;50(2):317-328is available online at: https://journals.lww.com/ccmjournal/Abstract/2022/02000/A_Systematic_Review_and_Pooled_Prevalence_of.16.aspx doi: 10.1097/CCM.0000000000005260
Published CitationSemple D, Howlett MM, Strawbridge JD, Breatnach CV, Hayden JC. A systematic review and pooled prevalence of delirium in critically ill children. Crit Care Med. 2022 Feb 1;50(2):317-328
Publication Date1 February 2022
- School of Pharmacy and Biomolecular Sciences
- Population Health and Health Services
- Chemistry and Pharmaceutical Sciences
- Health Professions Education
PublisherLippincott Williams & Wilkins
- Accepted Version (Postprint)