(843) Pediatric ICU Delirium Prevalence and Antipsychotic Prescribing Trends: A Multicenter Cohort Study

Introduction: Guidelines published in 2022 by the Society of Critical Care Medicine recommend against routine use of antipsychotics for ICU delirium. We sought to estimate the prevalence of ICU delirium and frequency of antipsychotic prescription among critically ill children.

Methods: We performed a multicenter, retrospective cohort study of critically ill children 0-17 years of age within the Pediatric Health Information System registry from Jan 2017 – Dec 2022. We excluded those with a primary mental health admission diagnosis. The primary outcome was delirium prevalence defined by ICD-10 diagnostic coding. The secondary outcome was antipsychotic prescribing frequency defined by pharmaceutical clinical transaction codes for haloperidol, risperidone, quetiapine, ziprasidone, and olanzapine. Delirium and antipsychotic prescribing trends were characterized by calendar year, participating center, clinical trajectory (e.g., mechanical ventilation [MV] exposure, central venous catheterization [CVC], length of stay [LOS]), and cumulative exposure to sedatives, hypnotics, analgesics, and anxiolytics agents. Statistical testing were descriptive (i.e., means, medians, and proportions) and comparative (i.e., chi-square, student’s t, and Wilcoxon rank-sum tests).

Results: Of the 595,881 encounters studied, 3,109 (0.5%) had ICU delirium of which 2,005 (64.5%) were prescribed an antipsychotic. We detected an increasing trend in delirium diagnosis (+0.04%/year) from 0.42% in 2017 to 0.59% in 2023 (r2=0.769). Those with delirium frequently underwent MV (80.6%), had a CVC (44.3%), were receiving postoperative care (62.7%), had a comorbid infection (74.7%), and were technology dependent (44.6%). Compared to children without delirium, those with were older (median 6.3 [IQR:1.7,13.7] vs 3.6 [IQR:0.9,10.9] years), had greater cumulative exposure to sedatives, hypnotics, analgesics, and anxiolytics agents (mean of 5 ± 2 vs 2 ± 2 agents), longer median LOS (24 [IQR:2,10] vs 4 [IQR:13,48] days), and increased in-hospital mortality rate (5.1% vs 2.3%) (all p< 0.001).

Conclusions: In this multicenter study, the prevalence of pediatric ICU delirium was 0.5% of whom 64.5% were prescribed antipsychotic agents. At this time, trial-derived efficacy data are needed to inform evidence-based practice guidelines.