Screening for Delirium During Pediatric Brain Injury Rehabilitation

William D Watson; Hsuan-Wei Chen; Adrian M Svingos; Ana K Ortiz; Stacy J Suskauer; Sudhin A Shah; Chani Traube

doi:10.1016/j.apmr.2024.02.729

Screening for Delirium During Pediatric Brain Injury Rehabilitation

Arch Phys Med Rehabil. 2024 Mar 5:S0003-9993(24)00842-6. doi: 10.1016/j.apmr.2024.02.729. Online ahead of print.

Authors

William D Watson¹, Hsuan-Wei Chen², Adrian M Svingos³, Ana K Ortiz⁴, Stacy J Suskauer⁵, Sudhin A Shah⁶, Chani Traube⁷

Affiliations

¹ Blythedale Children's Hospital, Valhalla, NY; Department of Rehabilitation & Regenerative Medicine, Columbia University, New York, NY. Electronic address: wwatson@blythedale.org.
² Kennedy Krieger Institute, Baltimore, MD.
³ Kennedy Krieger Institute, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.
⁴ Blythedale Children's Hospital, Valhalla, NY.
⁵ Kennedy Krieger Institute, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
⁶ Department of Radiology, Weill Cornell Medicine, New York, NY.
⁷ Department of Pediatrics, Weill Cornell Medicine, New York, NY.

PMID: 38452881
DOI: 10.1016/j.apmr.2024.02.729

Abstract

Objective: To assess feasibility of routine delirium screening using the Cornell Assessment of Pediatric Delirium (CAPD) in children admitted for rehabilitation with acquired brain injury (ABI), report on the prevalence of positive delirium screens in this population, and explore longitudinal trends in CAPD scores and their association with rehabilitation outcomes.

Design: Retrospective study.

Setting: Pediatric inpatient rehabilitation unit.

Participants: 144 children (median 10.8 years) with ABI (N=144).

Interventions: Not applicable.

Main outcome measures: Percent compliance with twice daily delirium screening; prevalence of positive delirium screens; trajectories in CAPD scores and their relation with FIM for Children (WeeFIM) scores.

Results: Screening was feasible (mean 75% compliance for each of 144 children). Of 16,136 delirium screens, 29% were positive. 62% of children had ≥1 positive screen. Four primary patterns of CAPD trajectories were identified: Static Encephalopathy (10%), Episodic Delirium (10%), Improving (32%), and No Delirium (48%). Validity of these trajectories was demonstrated through association with WeeFIM and CALS outcomes. Younger age at admission was associated with positive delirium screens, and rehabilitation length of stay was significantly longer for the Improving group.

Conclusions: Delirium occurs frequently in children with ABI during inpatient rehabilitation. Routine delirium screening provides clinically relevant information including the potential to facilitate early detection and intervention for medical complications. Longitudinal ratings of delirium symptoms may also have a role in developing a standardized definition for Post Traumatic Confusional State (PTCS) stage of recovery in children.

Keywords: Acquired brain injury; Delirium; Inpatient rehabilitation; Pediatrics; Rehabilitation.