Documenting Pediatric Delirium During Transitions of Care: A Single Site Observational Study.

Abstract

BackgroundDelirium is a common complication of illness. Patients who experience delirium are at risk for worse outcomes during and after hospitalization. This study aims to describe rates of, and factors associated with, delirium documentation during care transitions for patients who screened positive for delirium in the pediatric intensive care unit (PICU) at transfer to the pediatric hospital medicine (PHM) service and discharge.MethodsDemographic and clinical characteristics were collected retrospectively on patients ages 0-21 years, without developmental delay, who screened positive via Cornell Assessment of Pediatric Delirium (CAPD) before transferring from PICU to PHM service of a tertiary-care children's hospital from 2016-2022. Primary outcomes were documentation of "delirium" at PICU transfer and hospital discharge. Statistical analysis included bivariate analysis and multivariate logistic regression.ResultsOf 337 encounters, 66 transfer (20%) and 62 discharge notes (18%) documented delirium. On bivariate analysis, older age, female sex, Hispanic ethnicity, prolonged and elevated CAPD scoring, longer PICU and hospital length of stay, mechanical ventilation (MV), and psychiatry consultation were associated with documentation at transfer. On logistic regression, Black race decreased odds (OR 0.275, 95% CI 0.08-0.84) while psychiatry consultation (OR 66.82, 24.45-212.25) and invasive MV (OR 6.495, 2.13-22.34) increased odds of documentation. Discharge documentation demonstrated similar associations, except sex and ethnicity were not associated, while neurology consultation was positively associated with documentation. On logistic regression, psychiatry consultation (OR 36.01, 14.51-100.71) and invasive MV (OR 2.96, 1.09-8.83) increased odds of documentation at discharge.ConclusionsDespite a validated screening tool, pediatric providers often fail to document delirium at PICU transfer and hospital discharge. Lack of documentation may leave patients and families at risk for worse outcomes.