Tomas Leng, Hanin H Ali, Justin E McKone, Georgia Sullivan, Travis R Kirkpatrick, James L Homme, Yu Kawai
{"title":"急诊科到PICU转移的回顾性队列研究：与住院24小时内谵妄发展相关的急诊科因素。","authors":"Tomas Leng, Hanin H Ali, Justin E McKone, Georgia Sullivan, Travis R Kirkpatrick, James L Homme, Yu Kawai","doi":"10.1097/PCC.0000000000003824","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Many PICU admissions start with presentation in the emergency department (ED). However, we do not know whether there are any ED-related factors associated with the subsequent development of pediatric delirium (PD) within 24 hours of PICU admission.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single-center ED and PICU serving a quaternary referral center in the United States.</p><p><strong>Patients: </strong>Children younger than 18 years old presenting to the ED between January 2022 and December 2023 who required direct admission to the PICU, and who had at least one positive delirium screening within 24 hours of the admission.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The presence of delirium in the PICU was defined as a Cornell Assessment of Pediatric Delirium (CAPD) score of 9 and higher. We identified 138 patients for the final analysis. Overall, 51 of 138 patients (37%) developed PD within 24 hours of admission. The majority of delirium cases were classified as hypoactive (53%, 27/51) and mixed (31%, 16/51) subtypes, while only 16% (8/51) were identified as hyperactive delirium. Factors associated with greater odds (95% CI) of delirium in the PICU in multivariable analysis were use of mechanical ventilation (odds ratio [OR], 3.42 [95% CI, 1.09-10.78]; p = 0.04) and intermittent urinary catheterization (OR, 3.7 [95% CI, 1.21-11.30]; p = 0.02). Initial CAPD score positively correlated with PICU length of stay (LOS; r = 0.32; p < 0.01), Pediatric Index of Mortality 3 (PIM 3) score (r = 0.26; p < 0.01), and negatively correlated with emergency severity index (ESI) in the ED (r = -0.35; p < 0.01).</p><p><strong>Conclusions: </strong>Mechanical ventilation and intermittent urinary catheterization in the ED are associated with greater odds of PD within 24 hours of PICU admission. CAPD at admission positively correlates with PICU LOS, PIM 3 scores, and negatively correlates with ESI in the ED.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Retrospective Cohort Study of Emergency Department to PICU Transfers: Emergency Department Factors Associated With Delirium Development Within 24 Hours of Hospitalization.\",\"authors\":\"Tomas Leng, Hanin H Ali, Justin E McKone, Georgia Sullivan, Travis R Kirkpatrick, James L Homme, Yu Kawai\",\"doi\":\"10.1097/PCC.0000000000003824\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Many PICU admissions start with presentation in the emergency department (ED). However, we do not know whether there are any ED-related factors associated with the subsequent development of pediatric delirium (PD) within 24 hours of PICU admission.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single-center ED and PICU serving a quaternary referral center in the United States.</p><p><strong>Patients: </strong>Children younger than 18 years old presenting to the ED between January 2022 and December 2023 who required direct admission to the PICU, and who had at least one positive delirium screening within 24 hours of the admission.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The presence of delirium in the PICU was defined as a Cornell Assessment of Pediatric Delirium (CAPD) score of 9 and higher. We identified 138 patients for the final analysis. Overall, 51 of 138 patients (37%) developed PD within 24 hours of admission. The majority of delirium cases were classified as hypoactive (53%, 27/51) and mixed (31%, 16/51) subtypes, while only 16% (8/51) were identified as hyperactive delirium. Factors associated with greater odds (95% CI) of delirium in the PICU in multivariable analysis were use of mechanical ventilation (odds ratio [OR], 3.42 [95% CI, 1.09-10.78]; p = 0.04) and intermittent urinary catheterization (OR, 3.7 [95% CI, 1.21-11.30]; p = 0.02). Initial CAPD score positively correlated with PICU length of stay (LOS; r = 0.32; p < 0.01), Pediatric Index of Mortality 3 (PIM 3) score (r = 0.26; p < 0.01), and negatively correlated with emergency severity index (ESI) in the ED (r = -0.35; p < 0.01).</p><p><strong>Conclusions: </strong>Mechanical ventilation and intermittent urinary catheterization in the ED are associated with greater odds of PD within 24 hours of PICU admission. CAPD at admission positively correlates with PICU LOS, PIM 3 scores, and negatively correlates with ESI in the ED.</p>\",\"PeriodicalId\":19760,\"journal\":{\"name\":\"Pediatric Critical Care Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-09-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PCC.0000000000003824\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PCC.0000000000003824","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
目的：许多PICU入院是在急诊科（ED）开始的。然而，我们不知道是否有ed相关因素与PICU入院24小时内儿童谵妄（PD）的后续发展相关。设计：回顾性队列研究。环境：单中心ED和PICU服务于美国的四级转诊中心。患者：在2022年1月至2023年12月期间在急诊科就诊的年龄小于18岁的儿童，需要直接入住PICU，并且在入院24小时内至少有一次谵妄筛查阳性。干预措施:没有。测量和主要结果：PICU中谵妄的存在被定义为康奈尔儿童谵妄评估（CAPD）评分为9分及以上。我们确定了138例患者进行最终分析。总体而言，138例患者中有51例（37%）在入院24小时内发生PD。大多数谵妄病例分为低活动性（53%,27/51）和混合性（31%,16/51）亚型，多活动性谵妄仅占16%（8/51）。在多变量分析中，与PICU中谵妄发生率（95% CI）较大相关的因素是机械通气（优势比[OR]， 3.42 [95% CI, 1.09-10.78]; p = 0.04）和间歇导尿（OR, 3.7 [95% CI, 1.21-11.30]; p = 0.02）。初始CAPD评分与PICU住院时间（LOS, r = 0.32, p < 0.01）、儿科死亡指数3 （PIM 3）评分（r = 0.26, p < 0.01）呈正相关，与急诊科急诊严重程度指数（ESI）负相关（r = -0.35, p < 0.01）。结论：急诊机械通气和间歇导尿与PICU入院24小时内PD的发生率相关。入院时的CAPD与PICU LOS、PIM 3评分正相关，与急诊时的ESI负相关。
Retrospective Cohort Study of Emergency Department to PICU Transfers: Emergency Department Factors Associated With Delirium Development Within 24 Hours of Hospitalization.
Objectives: Many PICU admissions start with presentation in the emergency department (ED). However, we do not know whether there are any ED-related factors associated with the subsequent development of pediatric delirium (PD) within 24 hours of PICU admission.
Design: Retrospective cohort study.
Setting: Single-center ED and PICU serving a quaternary referral center in the United States.
Patients: Children younger than 18 years old presenting to the ED between January 2022 and December 2023 who required direct admission to the PICU, and who had at least one positive delirium screening within 24 hours of the admission.
Interventions: None.
Measurements and main results: The presence of delirium in the PICU was defined as a Cornell Assessment of Pediatric Delirium (CAPD) score of 9 and higher. We identified 138 patients for the final analysis. Overall, 51 of 138 patients (37%) developed PD within 24 hours of admission. The majority of delirium cases were classified as hypoactive (53%, 27/51) and mixed (31%, 16/51) subtypes, while only 16% (8/51) were identified as hyperactive delirium. Factors associated with greater odds (95% CI) of delirium in the PICU in multivariable analysis were use of mechanical ventilation (odds ratio [OR], 3.42 [95% CI, 1.09-10.78]; p = 0.04) and intermittent urinary catheterization (OR, 3.7 [95% CI, 1.21-11.30]; p = 0.02). Initial CAPD score positively correlated with PICU length of stay (LOS; r = 0.32; p < 0.01), Pediatric Index of Mortality 3 (PIM 3) score (r = 0.26; p < 0.01), and negatively correlated with emergency severity index (ESI) in the ED (r = -0.35; p < 0.01).
Conclusions: Mechanical ventilation and intermittent urinary catheterization in the ED are associated with greater odds of PD within 24 hours of PICU admission. CAPD at admission positively correlates with PICU LOS, PIM 3 scores, and negatively correlates with ESI in the ED.
期刊介绍：
Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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