A Clinical Survey Of Epidemiological Characteristics And Risk Factors Of The First Onset Of Intensive Care Unit Pediatric Delirium

Objectives1.To describe and analyze the epidemiological characteristics of the first onset of ICU(Intensive care unit)pediatric delirium,including the prevalence,the first onset time,the duration,and the types of ICU pediatric delirium.2.To analyze and discuss risk factors of the first onset of ICU pediatric delirium.Methods1.Based on the Cochrane Handbook for Systematic Reviews and method of overviews of reviews,using AMSTAR to evaluate the methodological quality of the retrieved systematic reviews,evaluating the systematic reviews related to risk factors for ICU delirium,and combining existing reports of ICU pediatric delirium,and finally the factors associated with ICU pediatric delirium were sorted out.2.This cross-sectional study was conducted in two pediatric intensive care units(PICU)within a tertiary-A general hospital in Shanghai,China.All pediatric patients admitted to the unit from December 1,2018 to August 31,2019,were included.Convenient sampling was used.Researchers selected study subjects strictly according to the inclusion and exclusion criteria.The researchers used the Chinese version of the Cornell Assessment of Pediatric Delirium to assess ICU pediatric delirium,and collected general demographic data,factors related to symptoms,and treatment and care-related conditions until the child died or was transferred out of the ICU.SPSS22.0(IBM Corp.,Armonk,NY,USA)was used for data analysis.Results1.639 patients were finally included in the analysis and the prevalence of ICU pediatric delirium was 31.30%.Among 3703 study days,delirium occurred in 581(15.69%)study days.Among 200 children with ICU delirium,the first onset of ICU pediatric delirium occurred within the first seven admission days to PICU.Among them,176 cases(88%)of delirium occurred in the first three admission days to PICU,148 cases(74%)of delirium occurred for the first time within 48 hours of admission to the PICU,95 cases(47.5%)of delirium occurred for the first time within 24 hours of admission of PICU;107 cases(53.5%)with the total number of ICU pediatric delirium duration days was one day.The average was 1.79(SD = 1.49)days of duration days of ICU pediatric delirium,the median was one day,and the longest duration was nine days,while the shortest was one day.36%of patient days with delirium were hyperactive,41% of patient days with delirium were hypoactive,and 23% of patient days with delirium were mixed-type.2.Multivariate logistic regression analysis showed that age,ICU retention time,renal dysfunction(OR,2.36;95% CI,1.44-3.87),infection(OR,3.26;95% CI,1.98-5.38),hypoxia(OR,2.55;95% CI,1.58-4.11),PRISM IV score,and mechanical ventilation(OR,3.62;95% CI,2.17-6.04)were statistically related to the first onset of ICU pediatric delirium.Patients aged 1-3 months,3-6 months,6-12 months,and 2-5 years old were respectively 9.26 times(95% CI,3.08-27.89),5.00 times(95% CI,1.89-13.28),6.05 times(95% CI,2.04-17.94)and 2.80 times(95% CI,1.03-7.61)more likely to have ICU pediatric delirium than patients aged 5-7 years;Patients whose ICU retention time were greater than 7 days remained 2.65 times(95% CI,1.49-4.74)likely to be delirious compared with who were 1-3 days;the odds of ICU pediatric delirium for subjects with PRISM IV score greater than 10 and PRISM IV score 5-10 was 3.53 times(95% CI,1.09-11.47)and 2.81 times(95% CI,1.65-4.79).In addition,univariate analysis showed statistically significant differences in diagnostic categories,sedative drugs,physical restraints,pre-ICU CPR,previous ICU admission,and emergency check-in ICU(P <0.05).3.The patients were divided into two subgroups based on the age of less than 2 years.The variables included in the two subgroup models were not exactly the same: ICU retention time,infection,hypoxia,PRISM IV score,and mechanical ventilation were independent risk factors for the first onset of delirium occurred in children with less than 2 years old;ICU retention time,renal dysfunction,hypoxia,and mechanical ventilation were independent risk factors for the first onset of delirium occurred in children with 2 years or older.Conclusions1.The prevalence of ICU pediatric delirium was high.Furthermore,the first onset of ICU pediatric delirium mainly occurred within the first three admission days to PICU,while most of them only lasted one day after the first episode,and the prevalence of hypoactive delirium is the highest.2.Age,ICU retention time,renal dysfunction,infection,hypoxia,PRISM IV score,and mechanical ventilation were independent risk factors for the first onset of ICU pediatric delirium.3.For different age subgroups,the risk factors for the first onset of ICU pediatric delirium that medical staffs need to focus on are different.