(1761) Incidence of Delirium in Pediatric Traumatic Brain Injury

Introduction: Delirium occurs in up to 69% of the general pediatric intensive care unit (PICU) population but the incidence in pediatric traumatic brain injury (TBI) is unknown. Approximately 60% of adults with TBI experience delirium. This study aims to describe the incidence of delirium and its association with outcomes in pediatric TBI patients.

Methods: A single center, retrospective, observational study of pediatric TBI patients admitted to a quaternary care PICU from January 2018-August 2023 was performed. TBI cases were stratified by first Glasgow Coma Scale (GCS) score into mild (GCS 13-15), moderate (GCS 9-12), or severe (GCS ≤ 8). Cornell Assessment of Pediatric Delirium (CAPD) scores are assessed by nursing every 12h in non-comatose (State Behavior Scale > -2) PICU patients and CAPD > 8 was categorized as delirious. Patients without any CAPD scores recorded were excluded. The incidence rate and 95% confidence interval (CI) for delirium was estimated overall and by TBI severity. The association of delirium with outcomes was examined using the Fisher exact or Kruskal-Wallis, as appropriate.

Results: Of 789 children with TBI, 464 had at least one CAPD score recorded. Of these, 280 were mild, 67 moderate, and 117 severe TBI patients. Overall incidence of delirium was 48.3% (95% CI=0.44, 0.53). Delirium incidence increased with increasing TBI severity: mild, moderate, and severe (28.6% [0.23, 0.34] vs. 64.2% [0.52, 0.76] vs. 86.3% [0.79, 0.92] p < 0.001). TBI patients with vs. without delirium had significantly longer median (range) duration (days) of mechanical ventilation (2.5 [0, 157] vs. 0 [0,16]), PICU length of stay (LOS) (5 [1, 135] vs. 2 [1,13]), and hospital LOS (12 [1,307] vs. 2 [1,24]) (all p < 0.001), but there was no difference in survival to hospital discharge (98.7% vs. 100%, p=0.11).

Conclusions: Delirium occurs in almost half of pediatric TBI patients, and the incidence increases with severity of injury in this population. Like adult TBI and pediatric patients without acute brain injury, the presence of delirium is associated with longer duration of mechanical ventilation and LOS. Future studies to delineate delirium etiology (primary brain injury vs. secondary ICU exposures) in the pediatric TBI population is warranted.