title: Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective, longitudinal cohort study.
  
  
  METHODS
  Urban academic tertiary care PICU.
  
  
  METHODS
  All consecutive admissions from September 2014 through August 2015.
  
  
  METHODS
  Children were screened for delirium twice daily throughout their ICU stay.
  
  
  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.
authors.affiliation: 1Department of Pediatrics, Weill Cornell Medical College, New York, NY. 2Department of Psychiatry, Weill Cornell Medical College, New York, NY. 3Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY. 4Weill Cornell Medical College, New York, NY. 5Department of Pediatrics, New York Presbyterian Hospital, New York, NY.
authors.forename: Chani
authors.initials: C
authors.lastname: Traube
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Silver
authors.forename: Linda M
authors.initials: LM
authors.lastname: Gerber
authors.forename: Savneet
authors.initials: S
authors.lastname: Kaur
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mauer
authors.forename: Abigail
authors.initials: A
authors.lastname: Kerson
authors.forename: Christine
authors.initials: C
authors.lastname: Joyce
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Greenwald
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000453:epidemiology / Q000401:mortality*; D003693:Delirium / Q000175:diagnosis* / Q000401:mortality*; D002658:Developmental Disabilities / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors