Impact of Delirium in the Pediatric Intensive Care Unit Two Months After Discharge

Introduction: Delirium is an increasingly recognized complication of critical illness. In adults, it has a lasting impact on quality of life, functionality, and neurocognitive outcomes. The long-term consequences of delirium in children are currently not well characterized. Our goal was to compare the outcomes of PICU survivors according to the presence of delirium during their PICU stay.


Methods: This is a retrospective cohort study of children followed at the CHU Sainte-Justine PICU follow-up clinic (inclusion criteria: ≥2 days of mechanical ventilation or ≥4 days of non-invasive ventilation). Two months after PICU discharge, patients and families were evaluated by a PICU physician, and filled out questionnaires (Pediatric Quality of Life InventoryTM,, Hospital Anxiety and Depression Scale). Delirium during PICU stay was defined as at least one Cornell Assessment of Pediatric Delirium (CAPD) score ≥ 9. Multivariable logistic regression models assessed the independent associations between delirium and our outcomes of interest while adjusting for age, sex, comorbidity, admission diagnosis, severity of illness (PELOD), PICU length of stay and mechanical ventilation.


Results: One hundred and fifty-one patients were included from October 2018 to December 2021, including 90 patients who had delirium (59.6%). Patients with delirium were more commonly intubated (77.6% vs. 22.4%, p< 0.001), had higher PELOD scores (10 [8-13] vs. 4 [2-9], p< 0.001), and longer lengths of stay (8.1 [4.9-14.9] vs. 5.4 [3.7-8.7] days, p=0.004). On multivariable analysis, delirium was associated with a decreased quality of life based on both physical (p=0.02) and psychological criteria (p=0.006). Delirium was not associated with sleep disturbances (OR 3.1, 95% CI: 0.9-10.6, p=0.07), increased fatigue (OR 1.8, 95% CI: 0.5-6.0, p=0.34), and parental anxiety (OR 1.0, 95% CI: 0.3-3.9, p=0.99) or depression (OR 3.6, 95% CI 0.9-14.3, p=0.07).


Conclusions: Children with delirium had a lower quality of life than non-delirious children two months following their PICU stay. These findings suggest a lasting effect of delirium on affected children.