Clinical characteristics, prevalence, and factors related to delirium in children of 5 to 14 years of age admitted to intensive care

Objective: To evaluate the clinical characteristics, prevalence and factors associated with delirium in critical patients from 5 to 14 years of age. Design: An analytical, cross-sectional observational study was made. Delirium was assessed with the Pediatric-Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU) and motor classification was established with the Delirium Rating Scale Revised-98. Setting: A pediatric Intensive Care Unit. Patients: All those admitted over a one-year period were assessed during the first 24-72 h, or when possible in deeply sedated patients. Exclusion criteria: Patients in stupor or coma, with severe communication difficulty, subjected to deep sedation throughout admission, and those with denied consent. Results: Twenty-nine of the 156 assessed patients suffered delirium (18.6%) and 55.2% were hypoactive. The neurocognitive alterations evaluated by the pCAM-ICU were similar in the three motor groups. Intellectual disability (OR = 17.54; 95%CI: 3.23-95.19), mechanical ventilation (OR = 18.80; 95%CI: 4.29-82.28), liver failure (OR = 54.88; 95%CI: 4.27-705.33), neurological disease (OR = 4.41; 95%CI: 1.23-15.83), anticholinergic drug use (OR = 3.23; 95%CI: 1.02-10.26), different psychotropic agents (OR = 4.88; 95%CI: 1.42-16.73) and tachycardia (OR = 4.74; 95%CI: 1.21-18.51) were associated to delirium according to the logistic regression analysis. Conclusion: The frequency of delirium and hypoactivity was high. It is therefore necessary to routinely evaluate patients with standardized instruments. All patients presented with important neurocognitive alterations. Several factors related with the physiopathology of delirium were associated to the diagnosis; some of them are modifiable through the rationalization of medical care.