دورية أكاديمية
Differences in Delirium Evaluation and Pharmacologic Management in Children With Developmental Delay: A Retrospective Case-Control Study.
| العنوان: | Differences in Delirium Evaluation and Pharmacologic Management in Children With Developmental Delay: A Retrospective Case-Control Study. |
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| المؤلفون: | Kolmar AR; Department of Pediatrics, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO, USA., Paton AM; Department of Pediatrics, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO, USA., Kramer MA; Department of Pediatrics, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO, USA., Guilliams KP; Department of Pediatrics, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.; Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.; Mallinckrodt Institution of Radiology, Division of Neuroradiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA. |
| المصدر: | Journal of intensive care medicine [J Intensive Care Med] 2024 Feb; Vol. 39 (2), pp. 170-175. Date of Electronic Publication: 2023 Aug 11. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Sage Publications Country of Publication: United States NLM ID: 8610344 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1489 (Electronic) Linking ISSN: 08850666 NLM ISO Abbreviation: J Intensive Care Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2002- : Thousands Oaks, CA : Sage Publications Original Publication: [Boston, MA : Little, Brown & Co., c1986- |
| مواضيع طبية MeSH: | Delirium*/diagnosis , Delirium*/drug therapy , Delirium*/epidemiology , Antipsychotic Agents*/therapeutic use, Child ; Humans ; Retrospective Studies ; Case-Control Studies ; Quality of Life ; Intensive Care Units ; Intensive Care Units, Pediatric |
| مستخلص: | Delirium is associated with increased mortality and cost, decreased neurocognition, and decreased quality of life in the pediatric intensive care unit (PICU) population. The Cornell Assessment for Pediatric Delirium (CAPD) is used in PICUs for delirium screening but lacks specificity in children with developmental delay (DD). Within a cohort of children receiving pharmacologic treatment for intensive care unit (ICU) delirium, we compared delirium scoring and medication management between children with and without DD. We hypothesized that CAPD scores and treatment decisions would differ between DD and neurotypical (NT) patients. In this retrospective case-control study, we queried the medical record of patients admitted to our PICU with respiratory failure from June 2018 to March 2022 who received antipsychotics typically used for ICU delirium. Antipsychotics prescribed for home use were excluded. Nonparametric statistics compared demographics, CAPD scores, medication choice, dosing (mg/kg), and medication continuation after discharge between those with and without DD based on the ICD-10 codes. Twenty-one DD admissions and 59 NT admissions were included. Groups did not significantly differ by demographics, LOS, drug, or initial dosage. DD patients had higher median CAPD scores at admission (17 vs 13; P = .02) and treatment initiation (18 vs 16.5; P = .05). Providers more frequently escalated doses in DD patients (13/21 vs 21/59; P = .04) and discharged them home on new antipsychotics (7/21 vs 5/59; P = .01). DD patients experience delirium screening and management differently than NT counterparts. Providers should be aware of baseline elevated scores in DD patients and carefully attend to indications for dosage escalation. Further work is needed to understand if prolonged duration, even after hospital discharge, benefits patients, or represents potential disparity in care. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
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| معلومات مُعتمدة: | P50 HD103525 United States HD NICHD NIH HHS |
| فهرسة مساهمة: | Keywords: developmental delay; disparities in care; pediatric delirium management; polypharmacy |
| المشرفين على المادة: | 0 (Antipsychotic Agents) |
| تواريخ الأحداث: | Date Created: 20230811 Date Completed: 20240108 Latest Revision: 20240315 |
| رمز التحديث: | 20240315 |
| مُعرف محوري في PubMed: | PMC10938448 |
| DOI: | 10.1177/08850666231194534 |
| PMID: | 37563949 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1525-1489 |
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| DOI: | 10.1177/08850666231194534 |