Improving Delirium Screening in Critically Ill Pediatric Trauma Patients.

Abstract

Background: Delirium is a complication of the critically ill and is associated with poor outcomes. While delirium screening protocols exist for critically ill adults, standardized screening approaches remain lacking for pediatric patients.

Objective: This study aims to evaluate a multicomponent delirium initiative's effectiveness in screening compliance and to identify risk factors for delirium in pediatric trauma patients.

Methods: This pre- and postintervention study was conducted at an urban Level I pediatric trauma center in western Pennsylvania, wherein critically ill children, ages 0 months to 18 years, admitted to the pediatric intensive care unit with traumatic injuries in 2020 and 2021 were screened for delirium using the Cornell Assessment of Pediatric Delirium tool. Interventions included nurse and physician education, screening tool relocation in the electronic health record, delirium score discussions during bedside rounds, and audits with real-time feedback.

Results: A total of 482 patients were included in the analysis, of which 13 (2.7%) were diagnosed with delirium; 9 (69%) had a head injury. Children with delirium were older, had greater Injury Severity Scores (26 [17-29] vs. 13 [9-21], p = .001), and had a greater likelihood of blood transfusion. Delirium screening compliance increased from 20% preintervention to 68% postintervention. Delirium was associated with increased intensive care unit length of stay and discharge to inpatient rehabilitation.

Conclusion: This multicomponent delirium intervention in pediatric trauma increased delirium screening rates and found that delirium is associated with increased length of stay and discharge disposition.