Incidence of pediatric delirium and withdrawal outside the PICU: findings from a pediatric cardiology ward.

Pediatric delirium, a severe acute brain dysfunction, is associated with increased mortality, morbidity, and prolonged hospital stays. Despite its substantial impact, it often goes unrecognized and is not routinely screened for, resulting in underrecognition. Delirium is common in pediatric intensive care units (PICUs), with a prevalence of 34% in a recent meta-analysis. However, data on its occurrence outside the PICU on general pediatric wards are limited. The objective of this study was to determine the incidence of delirium and withdrawal in hospitalized children and adolescents in a pediatric cardiology ward. We conducted a prospective observational study at a tertiary referral center, including all admissions between January 1 and December 31, 2022. Pediatric delirium and withdrawal were screened using the validated Sophia Observation Scale-Pediatric Delirium (SOS-PD), as part of a nurse-driven screening protocol. We evaluated 596 continuous admissions and found that 94 (15.8%) were affected by pediatric delirium, withdrawal, or both. A positive SOS-PD score was associated with an increased length of hospital stay (13 days vs. 3 days; p < 0.001) and treatment in our PICU (89.4% vs. 24.1%, p < 0.001). Patients with a positive SOS-PD score were also younger (0.5 years vs. 3 years, p < 0.001), and most were suffering from congenital heart disease (89.4% vs. 51%; p < 0.001).

conclusionDelirium and withdrawal occur frequently outside the PICU, affecting more than one in six patients in a pediatric cardiology ward. A nurse-driven screening using the SOS-PD can identify affected patients and possible risk factors. WHAT IS KNOWN: • Pediatric delirium is a severe acute brain dysfunction associated with increased mortality, morbidity, and prolonged hospital stays. • Despite its clinical relevance, pediatric delirium is often under-recognized and rarely screened for outside pediatric intensive care units (PICUs). WHAT IS NEW: • Delirium and withdrawal occur frequently outside the PICU, affecting over one in six patients in a pediatric cardiology ward. • Nurse-driven screening using the SOS-PD is feasible for identifying affected patients on general pediatric wards.