L. M. Einterz1, R. I. Muraru2, J. Raymond3, M. P. Landman4 1Indiana University School Of Medicine, Indianapolis, IN, USA 2Indiana University School Of Medicine, Data Coordinator CORES – Surgical Outcomes & Quality Improvement Center – Dept Of Surgery IU, Indianapolis, IN, USA 3Riley Children’s Hospital, Trauma Program, Indianapolis, IN, USA 4Riley Children’s Hospital, Riley Hospital For Children, Division Of Pediatric Surgery, Indianapolis, IN, USA
Introduction:
While much research has been done regarding intensive care unit (ICU) delirium in adults, less knowledge exists regarding the effects of delirium in vulnerable pediatric populations. Previous studies found that >25% of PICU patients may have delirium and that delirium is associated with worsening prognosis and increased length of stay (LOS). We hypothesized that pediatric trauma patients with neurotrauma would have higher rates of delirium than pediatric trauma patients without neurotrauma.
Methods:
A retrospective review was performed of pediatric trauma patients at a Level 1 pediatric trauma center from 2019-2022. Exclusion criteria included death within 24 hours of ICU admission and non-traumatic injury mechanisms such as drownings, suffocations, overdoses, and hangings. Neurotrauma was defined as an abbreviated injury score code of 2 or greater. Cornell Assessment of Pediatric Delirium (CAPD) was used per American College of Critical Care Medicine guidelines and a score of 9 or greater was considered positive for delirium.
Results:
446 patients met inclusion criteria, and 37.5% percent had a least one CAPD assessment during their ICU admission. Factors associated with patients having at least one delirium assessment on univariate analysis included: ED arrival, GCS, Injury severity score (ISS), total ventilator days, total ICU days, hospital LOS, and mortality. In these assessed patients, age (p=0.03), arrival GCS (p<0.001), total ventilator days (p<0.001), and ICU LOS (p<0.001) were associated with positive delirium scores (any CAPD score > or equal to 9). On multivariate logistic regression modeling, when controlling for significant clinical factors associated with delirium, both ICU LOS (OR 1.25, 95% CI 1.09-1.42, p=0.001) and total ventilator days (OR 1.096, 95% CI 1.03-1.16, p=0.002) were associated with delirium. There was no statistically significant relationship between neurotrauma and delirium (p=.115), on multivariate analysis.
Conclusion:
In this cohort of pediatric trauma patients managed in the ICU and at risk for delirium, variable assessment of delirium occurred. When controlling for risk factors for delirium, ICU LOS and total ventilator days were associated with delirium on CAPD assessment. The presence of neurotrauma was not associated with delirium. Ongoing research into risk factors as well as prevention strategies should be assessed in this population.