DOI: 10.1097/pcc.0000000000003678 ISSN: 1529-7535

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
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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.

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