• Razvan Azamfirei, Deanna Behrens, Sofia Padilla, Kate Madden, Sarah Goldberg, Megan Geno, Mary-Jeanne Manning, Michelle Piole, Erik Madsen, Danielle Maue, Samer Abu-Sultaneh, Ronke Awojoodu, Nae-Yuh Wang, Dale M Needham, Karin Neufeld, and Sapna R Kudchadkar.
• Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
• Pediatr Crit Care Me. 2024 Oct 1; 25 (10): 880888880-888.

ObjectivesTo determine the patient-level factors associated with performing daily delirium screening in PICUs with established delirium screening practices.DesignA secondary analysis of 2019-2020 prospective data from the baseline phase of the PICU Up! pilot stepped-wedge multicenter trial (NCT03860168).SettingSix PICUs in the United States.PatientsOne thousand sixty-four patients who were admitted to a PICU for 3 or more days.InterventionsNone.Measurements And Main ResultsOf 1064 patients, 74% (95% CI, 71-76%) underwent delirium screening at least once during their PICU stay. On 57% of the 8965 eligible patient days, screening was conducted. The overall prevalence of delirium was 46% across all screened days, and 64% of screened patients experienced delirium at some point during their PICU stay. Factors associated with greater adjusted odds ratio (aOR) of increased daily delirium screening included PICU stay longer than 15 days compared with 1-3 days (aOR 3.36 [95% CI, 2.62-4.30]), invasive mechanical ventilation as opposed to room air (aOR 1.67 [95% CI, 1.32-2.12]), dexmedetomidine infusions (aOR 1.23 [95% CI, 1.04-1.44]) and propofol infusions (aOR 1.55 [95% CI, 1.08-2.23]). Conversely, decreased aOR of daily delirium screening was associated with female gender (aOR 0.78 [95% CI, 0.63-0.96]), and the administration of continuous infusions of opioids (aOR 0.75 [95% CI, 0.63-0.90]) or ketamine (aOR 0.48 [95% CI, 0.29-0.79]). Neither patient age, the presence of family or physical restraints, or benzodiazepine infusions were associated with daily delirium screening rates.ConclusionsIn the 2019-2020 PICU UP! cohort, across six PICUs, delirium screening occurred on only 57% of days, despite the presence of established practices. Female gender, patients in the early stages of their PICU stay, and patients not receiving mechanical ventilation were associated with lower odds of daily delirium screening. Our results highlight the need for structured quality improvement processes to both standardize and increase the frequency of delirium screening.Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

35 keywords...

hide…