A Quality Improvement Initiative to Characterize and Address Delirium in Critically Ill Pediatric Trauma Patients
Amy Vestovich, Stephen Strotmeyer, Michelle Shaffer, *Ward Richardson, *Barbara A. Gaines, Dennis W. Simon, *Christine Perlick
UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
Background (issue): Delirium, an acute change in attention and cognition due to underlying illness or treatment, is associated with increased length of stay (LOS), duration of mechanical ventilation, and mortality in critically ill children. We report clinical characteristics from a single-center quality improvement (QI) initiative to address delirium in pediatric trauma patients. Setting: Level 1 Pediatric Trauma Center; Patients with traumatic injury admitted to pediatric intensive care unit (PICU)
Methods: A nursing-led multidisciplinary QI initiative to address delirium was launched in 2019. Interventions included: structured staff education, incorporation of the Cornell Assessment of Pediatric Delirium (CAPD) into the electronic health record, presentation of CAPD during rounds with a target of twice daily assessment with > 90% compliance, daily audits with real-time email reminders, and evidence-based guidelines for environmental and behavioral health interventions. PICU admissions with a traumatic injury between 2020-2021 were analyzed. Descriptive statistics and 2-sided Mann-Whitney test was performed. A p-value < 0.05 determined significance.
Findings: Of 482 injured children admitted to the PICU, 13 (2.7%) were diagnosed with delirium; 9 of 13 had a head injury. The average time to diagnosis was 8.3±5.6 days. In children with head injury, delirium was associated with older age (12.6±2.9 vs. 8.2±5.8 years), longer ICU LOS (10.9±10.8 vs. 2.9±4.7 days), and longer duration of mechanical ventilation (5.9±8.0 vs. 1.4±4.2 days; p<0.05 for all). Children with delirium had a trend towards greater severity of head injury (head AIS score 3.9±1.3 vs. 3.3±1.1; p=0.08). CAPD assessments have increased to 68% completion rate, which is below our benchmark of > 90% compliance.
Conclusions (implications for practice):Delirium in critically ill pediatric trauma patients is associated with increased PICU LOS and duration of mechanical ventilation. A QI initiative to address delirium in pediatric trauma patients has increased screening but has not yet met our 90% compliance benchmark.
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