Matthew S Hazle, Gabrielle Horner, Melissa Ross, Harlan McCaffery, Nasuh Malas, Erin F Carlton, Emily Jacobson
{"title":"记录儿童谵妄过渡期间护理:单点观察性研究。","authors":"Matthew S Hazle, Gabrielle Horner, Melissa Ross, Harlan McCaffery, Nasuh Malas, Erin F Carlton, Emily Jacobson","doi":"10.1177/08850666251339457","DOIUrl":null,"url":null,"abstract":"<p><p>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.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251339457"},"PeriodicalIF":3.0000,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Documenting Pediatric Delirium During Transitions of Care: A Single Site Observational Study.\",\"authors\":\"Matthew S Hazle, Gabrielle Horner, Melissa Ross, Harlan McCaffery, Nasuh Malas, Erin F Carlton, Emily Jacobson\",\"doi\":\"10.1177/08850666251339457\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>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.</p>\",\"PeriodicalId\":16307,\"journal\":{\"name\":\"Journal of Intensive Care Medicine\",\"volume\":\" \",\"pages\":\"8850666251339457\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-05-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Intensive Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/08850666251339457\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Intensive Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/08850666251339457","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景:谵妄是疾病的常见并发症。经历谵妄的患者在住院期间和住院后的预后更差。本研究旨在描述在儿科重症监护病房(PICU)筛查为谵妄阳性的患者在转到儿科医院医学(PHM)服务和出院时谵妄记录的比率和相关因素。方法回顾性收集某三级儿童医院2016-2022年从PICU转至PHM服务前通过Cornell Assessment of Pediatric Delirium (CAPD)筛查阳性的0-21岁无发育迟缓患者的人口学和临床特征。主要结局是在PICU转移和出院时记录“谵妄”。统计分析包括双变量分析和多变量logistic回归。结果337例就诊中,66例转院(20%)和62例出院(18%)记录谵妄。在双变量分析中,年龄较大、女性、西班牙裔、CAPD评分延长和升高、PICU和住院时间较长、机械通气(MV)和精神病学咨询与转移时的记录相关。在logistic回归中,黑人降低了患病几率(OR 0.275, 95% CI 0.08-0.84),而精神病学咨询(OR 66.82, 24.45-212.25)和侵入性MV (OR 6.495, 2.13-22.34)增加了患病几率。除性别和种族无关外,出院文件也显示出类似的关联,而神经病学咨询与文件正相关。在logistic回归分析中,精神病学咨询(OR 36.01, 14.51-100.71)和侵入性MV (OR 2.96, 1.09-8.83)增加了出院记录的几率。结论:尽管有一种有效的筛查工具,但儿科医生在PICU转移和出院时往往无法记录谵妄。缺乏文件可能会使患者和家属面临更糟糕结果的风险。
Documenting Pediatric Delirium During Transitions of Care: A Single Site Observational Study.
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.
期刊介绍:
Journal of Intensive Care Medicine (JIC) is a peer-reviewed bi-monthly journal offering medical and surgical clinicians in adult and pediatric intensive care state-of-the-art, broad-based analytic reviews and updates, original articles, reports of large clinical series, techniques and procedures, topic-specific electronic resources, book reviews, and editorials on all aspects of intensive/critical/coronary care.