Delirium in Children Undergoing Hematopoietic Cell Transplantation: A Multi-Institutional Point Prevalence Study

Chani Traube, Linda M. Gerber, Elizabeth A. Mauer, Keshia Small, Larisa Broglie, Yogi Raj Chopra, Christine N. Duncan, Christen L. Ebens, Julie C. Fitzgerald, Jason L. Freedman, Michelle P. Hudspeth, Caitlin Hurley, Kris M. Mahadeo, Jennifer McArthur, Miriam C. Shapiro, Matthew P. Sharron, Donna A. Wall, Matt S. Zinter, Bruce M. Greenwald, Gabrielle SilverFarid Boulad

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Delirium occurs frequently in adults undergoing hematopoietic cell transplantation, with significant associated morbidity. Little is known about the burden of delirium in children in the peri-transplant period. This study was designed to determine delirium rates, define risk factors (demographic and treatment related), and establish feasibility of multi-institutional bedside screening for delirium in children undergoing hematopoietic cell transplant. Methods: This is a multi-institutional point prevalence study. All subjects were prospectively screened for delirium twice daily using the Cornell Assessment of Pediatric Delirium over a 10-day period. De-identified data, including basic demographics and daily characteristics, were extracted from the electronic medical record. Results: Eleven North American institutions were included, 106 children were enrolled, and 883 hospital days were captured. Delirium screening was successfully completed on more than 98% of the study days. Forty-eight children (45%) developed delirium over the course of the 10-day study. Children were diagnosed with delirium on 161/883 study days, for an overall delirium rate of 18% per day. Higher delirium rates were noted in children <5 years old (aOR 0.41 for children over 5 years), and in association with specific medications (melatonin, steroids, and tacrolimus). Conclusion: Delirium was a frequent occurrence in our study cohort, with identifiable risk factors. Delirium screening is highly feasible in the pediatric hematopoietic cell transplant patient population. A large-scale prospective longitudinal study following children throughout their transplant course is urgently needed to fully describe the epidemiology of pediatric delirium, explore the effects of delirium on patient outcomes, and establish guidelines to prevent and treat delirium in the peri-transplant period.

Original languageEnglish (US)
Article number627726
JournalFrontiers in Oncology
Volume11
DOIs
StatePublished - Apr 22 2021

Bibliographical note

Funding Information:
This article was supported by the Weill Cornell Medical College (WCMC) Clinical and Translational Science Center (CTSC) (UL1 TR000457) and the National Cancer Institute (NCI) at the National Institutes of Health (NIH) (R01-CA244500).

Publisher Copyright:
© Copyright © 2021 Traube, Gerber, Mauer, Small, Broglie, Chopra, Duncan, Ebens, Fitzgerald, Freedman, Hudspeth, Hurley, Mahadeo, McArthur, Shapiro, Sharron, Wall, Zinter, Greenwald, Silver and Boulad.

Keywords

  • cancer
  • cornell assessment of pediatric delirium
  • delirium
  • hematopoietic cell transplant
  • incidence
  • pediatric oncology
  • risk factors

PubMed: MeSH publication types

  • Journal Article

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