Weill Cornell Medical College, New York, NY.
Department of Population Health Sciences, Weill Cornell Medical College, New York, NY.
Pediatr Crit Care Med. 2022 Oct 1;23(10):766-773. doi: 10.1097/PCC.0000000000003037. Epub 2022 Jul 27.
Delirium in critically ill children is associated with increased in-hospital morbidity and mortality. Little is known about the lingering effects of pediatric delirium in survivors after hospital discharge. The primary objective of this study was to determine whether children with delirium would have a higher likelihood of all-cause PICU readmission within 1 calendar year, when compared with children without delirium.
Retrospective cohort study.
Tertiary care, mixed PICU at an urban academic medical center.
Index admissions included all children admitted between September 2014 and August 2015. For each index admission, any readmission occurring within 1 year after PICU discharge was captured.
Every child was screened for delirium daily throughout the PICU stay.
Among 1,145 index patients, 166 children (14.5%) were readmitted at least once. Bivariate analyses compared patients readmitted within 1 year of discharge with those not readmitted: complex chronic conditions (CCCs), increased severity of illness, longer PICU length of stay, need for mechanical ventilation, age less than 6 months, and a diagnosis of delirium were all associated with subsequent readmission. A multivariable logistic regression model was constructed to describe adjusted odds ratios for readmission. The primary exposure variable was number of delirium days. After controlling for confounders, critically ill children who experienced greater than 2 delirium days on index admission were more than twice as likely to be readmitted (adjusted odds ratio, 2.2; CI, 1.1-4.4; p = 0.023). A dose-response relationship was demonstrated as children with longer duration of delirium had increased odds of readmission.
In this cohort, delirium duration was an independent risk factor for readmission in critically ill children. Future research is needed to determine if decreasing prevalence of delirium during hospitalization can decrease need for PICU readmission.
危重病患儿发生谵妄与住院期间发病率和死亡率增加有关。但对于出院后存活的患儿，儿科谵妄的持续影响知之甚少。本研究的主要目的是确定与无谵妄的患儿相比，谵妄患儿在出院后 1 年内是否更有可能因任何原因再次入住儿科重症监护病房（PICU）。
回顾性队列研究。
城市学术医疗中心的三级护理、混合儿科重症监护病房。
入选标准为 2014 年 9 月至 2015 年 8 月间所有入住 PICU 的患儿。对于每次 PICU 出院后的入院，均记录了 1 年内的再入院情况。
所有患儿在 PICU 住院期间每天均进行谵妄筛查。
在 1145 例指数患者中，有 166 例（14.5%）患儿至少有一次再入院。对 1 年内再入院的患儿与未再入院的患儿进行了单变量分析：复杂的慢性疾病（CCCs）、疾病严重程度增加、PICU 住院时间延长、需要机械通气、年龄小于 6 个月以及诊断为谵妄均与随后的再入院有关。构建了多变量逻辑回归模型以描述再入院的调整比值比。主要暴露变量是谵妄天数。在控制混杂因素后，在指数入院时经历大于 2 天谵妄的危重病患儿再次入院的可能性是未经历的两倍以上（调整比值比，2.2；95%CI，1.1-4.4；p=0.023）。随着谵妄持续时间的延长，患儿再次入院的几率也随之增加，呈现出剂量反应关系。
在本队列中，谵妄持续时间是危重病患儿再入院的独立危险因素。需要进一步的研究来确定住院期间谵妄发生率的降低是否可以减少 PICU 再入院的需求。
