Family Presence at the PICU Bedside and Pediatric Patient Delirium: Retrospective Analysis of a Single-Center Cohort, 2014-2017.

Autor:	Smith MB; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO., Killien EY; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.; Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, WA., Watson RS; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.; Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, WA., Dervan LA; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.; Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, WA.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2024 Dec 20. Date of Electronic Publication: 2024 Dec 20.
DOI:	10.1097/PCC.0000000000003678
Abstrakt:	Objectives: To examine the association between family presence at the PICU bedside and daily positive delirium screening scores. Design: Retrospective cohort study. Setting: Tertiary children's hospital PICU. Subjects: Children younger than 18 years old with PICU length of stay greater than 36 hours enrolled in the Seattle Children's Hospital Outcomes Assessment Program from 2014 to 2017. Interventions: None. Measurements and Main Results: In the dataset, delirium screening had been performed bid using the Cornell Assessment of Pediatric Delirium, with scores greater than or equal to 9 classified as positive. Family presence was documented every 2 hours. Among 224 patients, 55% (n = 124/224) had positive delirium screening on 44% (n = 408/930) of PICU days. Family presence at the bedside during PICU stay (< 90% compared with ≥ 90%) was associated with higher proportion of ever (as opposed to never) being screened positive for delirium (26/37 vs. 98/187; difference, 17.9% [95% CI, 0.4-32.1%]; p = 0.046). On univariate analysis, each additional decile of increasing family presence was associated with lower odds of positive delirium screening on the same day (odds ratio [OR], 0.87 [95% CI, 0.77-0.97]) and subsequent day (OR, 0.84 [95% CI, 0.75-0.94]). On multivariable analysis after adjustments, including baseline Pediatric Cerebral Performance Category (PCPC), higher family presence was associated with lower odds of subsequent-day positive delirium screening (OR, 0.89 [95% CI, 0.81-0.98]). Among patients with PCPC less than or equal to 2, each additional decile of increasing family presence was independently associated with lower odds of both same-day (OR, 0.90 [95% CI, 0.81-0.99]) and subsequent-day (OR, 0.85 [95% CI, 0.76-0.95]) positive delirium screening. Conclusions: In our 2014-2017 retrospective cohort, greater family presence was associated with lower odds of delirium in PICU patients. Family presence is a modifiable factor that may mitigate the burden of pediatric delirium, and future studies should explore barriers and facilitators of family presence in the PICU. Competing Interests: Dr. Killien’s institution received funding from the National Institute of Child Health and Human Development; she received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Databáze:	MEDLINE
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