Delirium in the Critically Ill Child: Assessment and Sequelae

ABSTRACT

Delirium is a common and serious neuropsychiatric complication in critically ill patients of all ages. In the context of critical illness, delirium may emerge as a result of a cascade of underlying pathophysiologic mechanisms and signals organ failure of the brain. Awareness of the clinical importance of delirium in adults is growing as emerging research demonstrates that delirium represents a serious medical problem with significant sequelae. However, our understanding of delirium in children lags significantly behind the adult literature. In particular, our knowledge of how to assess delirium is complicated by challenges in recognizing symptoms of delirium in pediatric patients especially in critical and intensive care settings, and our understanding of its impact on acute and long-term functioning remains in its infancy. This paper focuses on (a) the challenges associated with assessing delirium in critically ill children, (b) the current literature on the outcomes of delirium including morbidity following discharge from PICU, and care-giver well-being, and (c) the importance of assessment in determining impact of delirium on outcome. Current evidence suggests that delirium is a diagnostic challenge for clinicians and may play a detrimental role in a child’s recovery after discharge from the pediatric intensive care unit (PICU). Recommendations are proposed for how our knowledge and assessment of delirium in children could be improved.

KEYWORDS:

• Critical illness
• child
• delirium
• long-term outcomes
• morbidity
• parent coping

Acknowledgments

The authors have no conflicts of interest to declare.

Funding

This work was supported by the Australian Government Research Training Program (RTP) Scholarship (Full-time base RTP Stipend Scholarship); the Paediatric Critical Research Group (the Paediatric Critical Care Research PhD Student Research Grant); and the Children’s Hospital Foundation (Children’s Hospital Foundation PhD Scholarship Top-Up Grant RPCPHD0032017).

Additional information

Funding

This work was supported by the Australian Government Research Training Program (RTP) Scholarship (Full-time base RTP Stipend Scholarship); the Paediatric Critical Research Group (the Paediatric Critical Care Research PhD Student Research Grant); and the Children’s Hospital Foundation (Children’s Hospital Foundation PhD Scholarship Top-Up Grant RPCPHD0032017).