Delirium in Children Undergoing Hematopoietic Stem Cell Transplants

项目总结/摘要 谵妄-定义为在潜在的环境中发生的意识和认知的急剧变化， 疾病-是成人造血干细胞移植（HSCT）的常见并发症， 相关的发病率和死亡率。这从未在儿童中进行过研究，儿童的风险因素可能会有所不同 主要是成年人。这项研究的中心假设是，接受HSCT的儿童在 在移植期间，谵妄的风险极高，并且谵妄与不良结局有关。 本申请的目的是：定义谵妄的流行病学，并测量其对 结果。这项前瞻性纵向队列研究将前瞻性地确定 1000名儿童在围移植期，并确定可改变的危险因素，易患谵妄 发展本研究还将确定谵妄对重要临床结局的影响，包括 神经认知功能这些结果将导致一个范式的转变，在提供给儿童的照顾，在2010年， 移植期本研究将由五个领先的儿科肿瘤学研究联盟执行。 在北美的移植中心，与领先的儿科谵妄研究小组合作， 美国的这项创新的建议将利用儿童谵妄的综合经验， HSCT团队将迫切需要的谵妄研究扩展到一个独特的和未经研究的人群。通过减少 谵妄率，儿科HSCT后的结果可以优化。这一建议与美国国立卫生研究院的新建议一致。 政策，以确保研究'包容整个生命'，并将进一步国家癌症研究所的 使命是推进科学知识，以帮助癌症患者活得更长，更健康。

Project Summary/Abstract Delirium -- defined as an acute change in awareness and cognition that occurs in the setting of an underlying illness -- is a common complication of hematopoietic stem cell transplantation (HSCT) in adults, with associated morbidity and mortality. This has never been studied in children, where risk factors may vary substantially from adults. The central hypothesis of this study is that children undergoing HSCT are at extremely high-risk for delirium during the peri-transplant period, and that delirium is linked to poor outcomes. The objectives of this application are: to define the epidemiology of delirium, and measure its effect on outcomes. This prospective longitudinal cohort study will prospectively establish the incidence of delirium in 1000 children in the peri-transplant period, and identify modifiable risk factors that predispose to delirium development. This study will also define the effect of delirium on important clinical outcomes, including neurocognitive function. These results will lead to a paradigm shift in the care delivered to children in the peri- transplant period. This study will be executed by a research consortium of five leading pediatric oncologic transplant centers in North America, in collaboration with the leading pediatric delirium research group in the United States. This innovative proposal will leverage the combined experience of the pediatric delirium and HSCT teams to expand urgently needed delirium research into a unique and unstudied population. By reducing delirium rates, outcomes after pediatric HSCT can be optimized. This proposal is consistent with the NIH’s new policy to ensure research ‘Inclusion Across the Lifespan’, and will further the National Cancer Institute’s mission to advance scientific knowledge in order to help people with cancer live longer, healthier lives.