(830) Delirium in Children Admitted to the Pediatric Intensive Care Unit From the Emergency Room

Introduction: Pediatric delirium (PD) can affect 1 in 3 children admitted to the pediatric intensive care unit (PICU) and is associated with poor outcomes. A significant proportion of children in the PICU are admitted from the emergency department (ED); however, risk factors related to the care provided in the ED and the development of PD in this PICU cohort are unknown. We aimed to determine the prevalence of PD in children admitted to the PICU from the local ED, and to evaluate for non-modifiable and ED-related risk factors associated with subsequent development of PD within 24 hours of PICU admission.

Methods: We performed a retrospective cohort study of all patients ≤18 years of age presenting to the local ED between January 2022 and December 2023 who required admission to the PICU. PD was defined as a Cornell Assessment of Pediatric Delirium (CAPD) score of ≥9. Patients without a documented CAPD within the first 24 hours of PICU admission were excluded. Patients' demographic and clinical characteristics, such as medication administered and respiratory support needed in the ED, were retrieved through our electronic medical records. An odds ratio (OR) analysis was performed to determine the risk factors for developing PD.

Results: Among 138 patients admitted to the PICU from the ED (mean age 5 years, 48% females), 51 (37%) developed PD within 24 hours of admission. The ED length of stay of those who developed PD was shorter than those who did not develop PD (3 vs 4 hours, P = 0.01). Arrival by ambulance (OR: 2.4, 95 % CI: 1.1–5.4), diagnosis of seizure in the ED (OR: 5.2, 95% CI: 1.3–20.6), mechanical ventilator use (OR: 4.1, 95 % CI: 1.6–10.5) and a urinary catheter placement (OR: 3.5, 95% CI: 1.3–9.6) in the ED were associated with PD. Administration of benzodiazepines (OR: 3.9, 95 % CI: 1.8–8.6), opioids (OR: 5.1, 95 % CI: 1.8–14.3), anticonvulsants (OR: 7.7, 95 % CI: 2–29.1) and anesthetics (excluding opioids and benzodiazepines) (OR: 15.8, 95% CI: 5.5–45.4) in the ED was also associated with PD.

Conclusions: A diagnosis of seizure, arrival by ambulance, ventilator use, urinary catheter placement and administration of benzodiazepines, opioids, anticonvulsants, and anesthetics in the ED are associated with higher odds of PD within 24 hours of PICU admission.