RECOGNIZING DELIRIUM IN HOSPITALIZED CHILDREN: A SYSTEMATIC REVIEW OF THE EVIDENCE ON RISK FACTORS AND CHARACTERISTICS

Holly C, Porter S, Echevarria M, Dreker M, Ruzehaji S. Am J Nurs. 2018;118(4):24-36.

In this descriptive epidemiological systematic review, the researchers sought to examine the evidence regarding the risk factors for and characteristics of acute pediatric delirium in hospitalized children. The research question was framed: "How do nurses recognize the risk factors and characteristics of delirium in children?" A descriptive epidemiological method was used as this method studies the distribution of a disease or condition for purposes of establishing prevention or management programs (or both) and informing planning and management of said conditions or diseases.

Twenty-one of 52 studies met the inclusion criteria established by the researchers involving 2612 subjects, to identify delirium risk factors in children from birth through 21 years of age and to identify characteristics of acute pediatric delirium. Findings included that pediatric patients who experience delirium have 5 characteristics that are commonly found, including agitation, disorientation, hallucinations, inattention, and sleep-wake cycle disturbances. It was also found that children in the pediatric intensive care unit or those who were seriously ill, those with a high Pediatric Risk Mortality II score, and children who were mechanically ventilated were at a greater risk of developing delirium. In addition, the researchers found that children who may have developmental delay or preexisting anxiety disorder, as well as boys, were more prone to developing delirium. The researchers found that delirium was multifactorial and may be related to treatment and hospital environment. The researchers also found that children who experience delirium may have increased hospital stay, thereby increasing costs.

The authors concluded that these findings may assist in early recognition and better management or prevention of delirium. In addition, this information may prevent unnecessary laboratory and imaging tests, which in turn can save patients and their family's unnecessary pain, anxiety, and increased hospital costs.