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Factors Associated With Delirium in Children: A Systematic Review and Meta-Analysis*

医学 优势比 梅德林 谵妄 科克伦图书馆 荟萃分析 可能性 内科学 儿科 重症监护医学 逻辑回归 政治学 法学
作者
Erwin Ista,Chani Traube,Marjorie de Neef,Jan N. M. Schieveld,Hennie Knoester,Marja Molag,Sapna R. Kudchadkar,Jacqueline J. M. H. Strik
出处
期刊:Pediatric Critical Care Medicine [Lippincott Williams & Wilkins]
卷期号:24 (5): 372-381 被引量:4
标识
DOI:10.1097/pcc.0000000000003196
摘要

Pediatric delirium (PD) is a neuropsychiatric syndrome caused by a complex interplay between predisposing factors (e.g., age, cognitive impairment), acute illness, and environmental triggers. PD is associated with substantial morbidity and mortality. The objective of this study is to systematically review and evaluate factors associated with PD in hospitalized pediatric patients.A systematic search of PubMed, Embase, Ovid Medline, Web- of-Science, Cochrane, CIHNAL, and Google Scholar databases was conducted for relevant studies (1990-2022).We included studies that compared pediatric patients with and without delirium. Reviews, editorials, congress abstracts, or studies that did not report factors for PD were excluded. No restrictions were imposed on language.Title and abstract were independently screened by two reviewers. Individual characteristics, study design, and outcomes were independently extracted.Categorical dichotomous data were summarized across groups using Mantel-Haenszel odds ratios (ORs) with 95% 95% CIs. Either fixed-effect or random effects models were used as indicated by the results of a heterogeneity test. Of 1,846 abstracts, 24 studies were included. We identified 54 factors studied in univariate analyses, and 27 of these were associated with PD in multivariable analyses. In pooled analyses, greater odds of PD were associated with developmental delay (OR 3.98; 95% CI 1.54-10.26), need for mechanical ventilation (OR 6.02; 95% CI 4.43-8.19), use of physical restraints (OR 4.67; 95% CI 1.82-11.96), and receipt of either benzodiazepines (OR 4.10; 95% CI 2.48-6.80), opiates (OR 2.88; 95% CI 1.89-4.37), steroids (OR 2.02; 95% CI 1.47-2.77), or vasoactive medication (OR 3.68; 95% CI 1.17-11.60).In this meta-analysis, we identified seven factors associated with greater odds of developing delirium during pediatric critical illness.
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