Lifting the Shade on Pediatric Acute Care Delirium —an Underrecognized Problem

Dr. Hadley Presenters: Nicholas Beam, MD, Jeri Kessenich, MD, Jillian Bybee, MD, and Brett Leingang, MD Delirium is underrecognized in the pediatric acute care spaces, both in the intensive care unit and on the general medical floors. Studies have reported that the incidence of pediatric delirium is 20% to 65% of pediatric intensive care unit (PICU) patients and 10% to 40% of all hospitalized children.1 Delirium is defined in the DSM-5 as a disturbance in attention and alertness, with an abrupt change from baseline, which fluctuates, is not explained by pre-existing neurocognitive disorders, and has evidence of a cause.2 Delirium can present as hypoactive (listless, withdrawn, reduced activity or awareness), hyperactive (restless, agitated, inconsolable), or mixed, motor sub-type. In pediatric patients, risk factors for delirium include age (less than two years old), mechanical ventilation, intensive care stay longer than five days, major surgery, presence of medical co-morbidities, and underlying developmental disabilities. Precipitating factors include drugs and toxins (barbiturates, benzodiazepines, antihistamines including diphenhydramine, narcotics, steroids, psychotropic meds, tricyclic antidepressants, etc.), infections, metabolic derangements, systemic organ failure, neurological disorders, and physical disorders. The PHM 2023 presenters shared a helpful mnemonic BRAIN MAPS to remember the causes.3 B: Bring oxygen: hypoxemia and anemia R: Reduce: remove deliriogenic...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Clinical Guidelines Pediatrics PHM Coverage Source Type: research