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DOI：
10.1097/01.ccm.0000550999.28870.e9
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发表时间：
2019
影响因子：
8.8
通讯作者：
S. Kudchadkar
中科院分区：
文献类型：
--
作者：
S. Barnes;C. Traube;S. Kudchadkar
研究方法：数据来自PARK-PICU研究，这是一项为期两天的全国性点患病率研究，研究了在专用儿科ICU住院超过72小时的儿童中的常规急性康复实践。在这项研究中，我们纳入了所有患有主要心脏病诊断（内科或外科）的儿童。谵妄筛查依从性定义为在过去24 h内进行谵妄筛查，阳性谵妄状态定义为在过去24 h内谵妄筛查阳性。其中52%的患者被送往专门的PCICU。54%的患者所在的单位已将谵妄筛查作为标准护理实施，其中85%的单位报告每班筛查一次谵妄。在这些单位中，82%使用康奈尔评估小儿谵妄筛查工具。在常规谵妄筛查的单位中，只有45%的患者有记录的谵妄筛查。在所有接受谵妄筛查的心脏病患者中，谵妄患病率为24%，心脏手术患者（21%）和内科患者（28%; p=. 276）。那些在专门的PCICU接受常规谵妄筛查的患者比在普通PICU接受常规谵妄筛查的患者更有可能接受谵妄筛查（55% vs. 33%; p< 0.001）。有谵妄患病率或筛查依从性年龄组之间没有差异。结论：在这个国家点患病率研究，谵妄筛查依从性低，即使在常规单位为基础的谵妄筛查的主要心脏病诊断的患者。在专门的PCICU中的患者更有可能接受筛查。本研究证实了先前在儿科心脏病患者中的患病率数据，并支持需要采取干预措施来提高弱势人群的谵妄筛查依从性。
Methods: Data were obtained from the PARK-PICU Study, a national two-day point prevalence study of routine acute rehabilitation practices in children admitted to a dedicated pediatric ICU> 72 hours. For this study, we included all children with a primary cardiac diagnosis (medical or surgical). Delirium screening compliance was defined as a delirium screen being conducted in the previous 24 hours and positive delirium status was defined as a positive delirium screen in the previous 24 hours.Results: 556 cardiac patients (43% F; 83%≤ 2 years) admitted to 54 PICU/PCICU were included. Fifty-two percent of these patients were admitted to a dedicated PCICU. Fifty-four percent of patients were in a unit where delirium screening had been implemented as the standard of care, and 85% of those units reported screening for delirium once per shift. Among these units, 82% utilized the Cornell Assessment of Pediatric Delirium screening tool. Only 45% of patients in units with routine delirium screening had a documented delirium screen. Delirium prevalence was 24% among all cardiac patients who were screened for delirium, and was not significantly different between cardiac surgical (21%) and medical patients (28%; p=. 276). Those admitted to a dedicated PCICU with routine delirium screening were more likely to be screened for delirium than patients in a general PICU with routine delirium screening (55% vs. 33%; p< 0.001). There was no difference in delirium prevalence or screening compliance between age groups.Conclusions: In this national point prevalence study, delirium screening compliance was low in patients with primary cardiac diagnoses even when routine unit-based delirium screening was in place. Patients in a dedicated PCICU are more likely to be screened. This study confirms previous prevalence data in pediatric cardiac patients and supports the need for interventions to improve delirium screening compliance in a vulnerable population.