Autor:innen:
A. Simma (Tübingen, DE)
F. Neunhoeffer (Tübingen, DE)
J. Engel (Tübingen, DE)
J. Schmidt (Tübingen, DE)
I. Ritthaler (Tübingen, DE)
S. Haase (Tübingen, DE)
Background: Pediatric delirium is a severe and acute brain dysfunction associated with increased mortality, morbidity, and prolonged hospital stays. Despite its significant impact, it is often missed and not routinely tested for, leading to its under-recognition. Delirium is a common finding in pediatric intensive care units, with a prevalence ranging from 15% to 60%. However, there is limited data on its occurrence in normal wards.
Objective: The aim of this study was to determine the incidence of delirium among hospitalized children and adolescents in a pediatric cardiology ward of a university hospital and to compare patients with delirium and withdrawal to those without.
Methods: In this prospective study, we used the validated Sophia Observation Scale – Pediatric Delirium (SOS-PD) and evaluated all patients in the pediatric cardiology ward three times daily during nursing routines. We included all patients who received at least one score and excluded patients who had an inpatient stay of less than 24 hours or were over 18 years of age. The study was approved by the local ethics committee.
Results: From January 1, 2022, to June 30, 2022, we screened 304 cases and found that 37 (12,2%) scored positive for delirium and 39 (12,8%) positive for withdrawal. As there is a significant overlap of these groups it results in a total of 46 (15,1%) cases that were affected by delirium, withdrawal, or both. Half of those were female (n = 23, 50%). Patients with a positive score were younger (mean age 1.2 years, SD 1.7 years, IQR 1.1 years) compared to those with a negative score (mean age 5.1 years, SD 5.5 years, IQR 8.2 years) (p < 0.001). Most affected patients received treatment on our interdisciplinary pediatric intensive care unit (1.3%) compared to 23.5% in the negative scored group (p = 0.01). There was no difference in length of stay in the pediatric intensive care unit (mean 10.9 days, SD 10.4 days, IQR 14 days vs. mean 8.25 days, SD 8.5 days, IQR 14 days) (p = 0.24), but affected patients had a significantly longer overall hospital stay (mean 20.5 days, SD 15.3 days, IQR 21.5 days vs. mean 6.5 days, SD 8.6 days, IQR 11 days) (p = 0.002).
Conclusion: This study suggests that delirium and withdrawal are a significant issue among infants, children, and adolescents hospitalized for medical or surgical conditions in a pediatric cardiology ward. Furthermore, our results show that the nurse-driven detection of delirium and withdrawal using the SOS-PD score is effective and feasible. More research is required to identify risk factors for delirium outside the PICU and to determine the point of occurrence to improve strategies for routine detection, prevention, and management.