What’s New in the Patient Safety World

August 2014

Delirium in Pediatrics

 

 

Virtually all our columns on delirium screening, diagnosis and management have focused on adult patients, particularly the elderly. However, recently there has been an interest kindled in recognition of delirium in pediatric patients.

 

One research group conducted a survey of pediatric intensivists regarding sedation management, sleep promotion, and delirium screening practices for intubated and mechanically ventilated children (Kudchadkar 2014). They found that delirium screening was not practiced in 71% of respondent’s PICUs, and only 2% reported routine screening at least twice a day. Use of earplugs, eye masks, noise reduction, and lighting optimization for sleep promotion was uncommon. Only 27% of respondents reported having written sedation protocols. And though 70% of respondents worked in PICUs with sedation scoring systems, only 42% of those with access to scoring systems reported routine daily use for goal-directed sedation management. There was also considerable variation in the drugs used for sedation.

 

A viewpoint in the July issue of JAMA Pediatrics by Schieveld and Janssen (Schieveld 2014) called for growing recognition of pediatric delirium. Specifically, the authors recommend use of diagnostic criteria for pediatric delirium such as use of the Cornell Assessment of Pediatric Delirium tool (Traube 2014). The CAPD is a rapid observational screening tool recently validated in a pediatric ICU (PICU) setting and found to have an overall sensitivity of 94.1% and specificity of 79.2%. Interestingly, in their study population Traube and colleagues found the overall prevalence rate of delirium was 20.6%. So while not as high as the 60-80% prevalence typically seen in adult ICU’s, it is clear that delirium is a common problem in pediatric critical care. The viewpoint article (Schieveld 2014) also noted the importance of inclusion of developmental “anchor” points to help in screening of very young children or those with developmental delay and called for use of flowcharts and continuous monitoring for delirium in the pediatric ICU patients.

 

 

Some of our prior columns on delirium assessment and management:

·         October 21, 2008 “Preventing Delirium”

·         October 14, 2009 “Managing Delirium”

·         February 10, 2009 “Sedation in the ICU: The Dexmedetomidine Study”

·         March 31, 2009 “Screening Patients for Risk of Delirium”

·         June 23, 2009  “More on Delirium in the ICU”

·         January 26, 2010 “Preventing Postoperative Delirium”

·         August 31, 2010 “Postoperative Delirium”

·         September 2011 “Modified HELP Helps Outcomes in Elderly Undergoing Abdominal Surgery”

·         December 2010 “The ABCDE Bundle”

·         February 28, 2012 “AACN Practice Alert on Delirium in Critical Care”

·         April 3, 2012 “New Risk for Postoperative Delirium: Obstructive Sleep Apnea”

·         August 7, 2012 “Cognition, Post-Op Delirium, and Post-Op Outcomes”

·         September 2013 “Disappointing Results in Delirium”

·         October 29, 2013 “PAD: The Pain, Agitation, and Delirium Care Bundle”

·         February 2014 “New Studies on Delirium”

·         March 25, 2014 “Melatonin and Delirium”

·         May 2014 “New Delirium Severity Score”

·         August 2014 “A New Rapid Screen for Delirium in the Elderly”

 

 

References:

 

 

Kudchadkar SR, Yaster M, Punjabi NM. Sedation, Sleep Promotion, and Delirium Screening Practices in the Care of Mechanically Ventilated Children: A Wake-Up Call for the Pediatric Critical Care Community. Crit Care Med 2014; 42(7): 1592-1600

http://journals.lww.com/ccmjournal/Abstract/2014/07000/Sedation,_Sleep_Promotion,_and_Delirium_Screening.2.aspx

 

 

Schieveld JNM, Janssen NJJF. Delirium in the Pediatric Patient. On the Growing Awareness of Its Clinical Interdisciplinary Importance. JAMA Pediatrics 2014; 168(7): 595-596

http://archpedi.jamanetwork.com/article.aspx?articleid=1867336

 

 

Traube C, Silver G, Kearney J, et al. Cornell Assessment of Pediatric Delirium: A Valid, Rapid, Observational Tool for Screening Delirium in the PICU. Critical Care Medicinem 2014; 42(3):656-663

http://journals.lww.com/ccmjournal/Abstract/2014/03000/Cornell_Assessment_of_Pediatric_Delirium__A_Valid,.20.aspx

 

 

 

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