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

Mallory B Smith; Elizabeth Y Killien; R Scott Watson; Leslie A Dervan

doi:10.1097/PCC.0000000000003678

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

Pediatr Crit Care Med. 2024 Dec 20. doi: 10.1097/PCC.0000000000003678. Online ahead of print.

Authors

Mallory B Smith¹, Elizabeth Y Killien^{2

3}, R Scott Watson^{2

3}, Leslie A Dervan^{2

4}

Affiliations

¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
² Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
³ Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, WA.
⁴ Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, WA.

PMID: 39704609
DOI: 10.1097/PCC.0000000000003678

Abstract

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.