• Chani Traube, Gabrielle Silver, Linda M Gerber, Savneet Kaur, Elizabeth A Mauer, Abigail Kerson, Christine Joyce, and Bruce M Greenwald.
• 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.
• Crit. Care Med. 2017 May 1; 45 (5): 891898891-898.

ObjectivesDelirium 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.DesignProspective, longitudinal cohort study.SettingUrban academic tertiary care PICU.PatientsAll consecutive admissions from September 2014 through August 2015.InterventionsChildren were screened for delirium twice daily throughout their ICU stay.Measurements And Main ResultsOf 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).ConclusionsDelirium 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.

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