Evaluation of Pediatric Delirium in Saudi Arabian PICUs:A Comprehensive Assessment of Awareness and Management
Main Article Content
Keywords
pediatric delirium, awareness, management, intensive care unit, healthcare professionals, Saudi Arabia
Abstract
Introduction: Pediatric delirium, a neuropsychiatric disorder, affects up to 66% of critically ill children, disrupting cerebral functioning. Often misdiagnosed or confused with other conditions, delirium remains a challenge in pediatric care. This study aims to evaluate the awareness, practices, and management strategies for pediatric delirium in Saudi Arabia among healthcare professionals working in pediatric intensive care units (PICUs). Method: A cross-sectional study was undertaken to assess pediatric delirium awareness and management among physicians practicing in PICUs across various healthcare facilities in Saudi Arabia. The study spanned from December 2023 to February 2024 and included physicians with expertise in pediatric delirium. Utilizing a validated tool, data analysis was performed using SPSS version 24®. Statistical analyses included chi-square and Fisher exact tests for categorical variables with two groups, and One-Way ANOVA for those with more than two groups. A p-value of less than 0.05 was deemed statistically significant. Results: Ninety-eight participants responded to the emailed questionnaire (response rate: 61.25%). Most were PICU consultants (53.1%) working in government hospitals (85.7%). Uncertainty prevailed regarding delirium prevalence in their units were (53.1%), with hyperactive delirium being the most reported type (31.6%). Preventive measures included maintaining a normal sleep-wake cycle (85.7%), modifying contributing factors (75.5%), and optimizing sedation goals (75.5%). The Cornell Assessment of Pediatric Delirium (CAP-D) was the primary assessment tool. Supportive treatment (60.2%), non-pharmacological interventions (58.2%), and benzodiazepines (41.8%) were common preventive measures. A statistically significant associations were found between professional qualification and recognizing delirium-mistaken conditions (p-value=0.001). PICUs with at least one consultant (p-value=0.023) and a nurse-to-patient ratio of 1:1 (p-value= <0.001) had significantly higher awareness, while single-patient rooms showed greater awareness compared to multiple-patient occupancy settings (p-value= 0.009) among healthcare professionals. Conclusion: The study identified inadequate knowledge for delirium and assessment in PICUs, it underscores the importance of enhancing the knowledge of consultants working in these units. Keeping in mind the side effects of pharmacological interventions, the modifiable factors and non-pharmacological management should be encouraged for achieving an optimal outcome of pediatric delirium.
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4. Patel AK, Biagas KV, Clarke EC, Gerber LM, Mauer E, Silver G, Chai P, Corda R, Traube C. Delirium in Children After Cardiac
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jpeds.2017.11.064
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pbc.27640
10. Simone S, Edwards S, Lardieri A, Walker LK, Graciano AL, Kishk OA, Custer JW. Implementation of an ICU Bundle: An
Interprofessional Quality Improvement Project to Enhance Delirium Management and Monitor Delirium Prevalence in a Single
PICU. Pediatr Crit Care Med. 2017 Jun;18(6):531-540. https://doi.org/10.1097/PCC.0000000000001127
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B. M. (2016). Cost Associated With Pediatric Delirium in the ICU. Critical care medicine, 44(12), e1175–e1179. https://doi.
org/10.1097/CCM.0000000000002004
12. Slater A, Shann F, Pearson G; Paediatric Index of Mortality (PIM) Study Group. PIM2: a revised version of the Paediatric Index
of Mortality. Intensive Care Med. 2003 Feb;29(2):278-85.https://doi.org/10.1007/s00134-002-1601-2
13. Ista E, Traube C, de Neef M, Schieveld J, Knoester H, Molag M, Kudchadkar SR, Strik J; Dutch Multidisciplinary Pediatric Delirium
Guideline Group. Factors Associated With Delirium in Children: A Systematic Review and Meta-Analysis. Pediatr Crit Care Med.
2023 May 1;24(5):372-381.https://doi.org/10.1097/PCC.0000000000003196
14. Patel AK, Bell MJ, Traube C. Delirium in Pediatric Critical Care. Pediatr Clin North Am. 2017 Oct;64(5):1117-1132.https://doi.
org/10.1016/j.pcl.2017.06.009 15. Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung
A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R; American College of Critical Care
Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive
care unit. Crit Care Med. 2013 Jan;41(1):263-306.
16. Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM Jr. A multicomponent
intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999 Mar 4;340(9):669-76. https://doi.
org/10.1056/NEJM199903043400901
17. Hshieh TT, Yang T, Gartaganis SL, Yue J, Inouye SK. Hospital Elder Life Program: Systematic Review and Meta-analysis of
Effectiveness. Am J Geriatr Psychiatry. 2018 Oct;26(10):1015-1033. https://doi.org/10.1016/j.jagp.2018.06.007
18. Denehy L, Lanphere J, Needham DM. Ten reasons why ICU patients should be mobilized early. Intensive Care Med. 2017
Jan;43(1):86-90. https://doi.org/10.1007/s00134-016-4513-2
19. Wieczorek B, Ascenzi J, Kim Y, Lenker H, Potter C, Shata NJ, Mitchell L, Haut C, Berkowitz I, Pidcock F, Hoch J, Malamed C,
Kravitz T, Kudchadkar SR. PICU Up!: Impact of a Quality Improvement Intervention to Promote Early Mobilization in Critically Ill
Children. Pediatr Crit Care Med. 2016 Dec;17(12):e559-e566. https://doi.org/10.1097/PCC.0000000000000983
20. Flaigle MC, Ascenzi J, Kudchadkar SR. Identifying Barriers to Delirium Screening and Prevention in the Pediatric ICU: Evaluation
of PICU Staff Knowledge. J Pediatr Nurs. 2016 Jan-Feb;31(1):81-4. https://doi.org/10.1016/j.pedn.2015.07.009
21. Selim AA, Ely EW. Delirium the under-recognised syndrome: survey of healthcare professionals’ awareness and practice in the
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Evaluation of Pediatric Delirium in Saudi Arabian PICUs:A Comprehensive Assessment of Awareness and Management. Pharm Pract (Granada) [Internet]. 2025 Oct. 8 [cited 2025 Oct. 22];23(3):1-12. Available from: https://pharmacypractice.org/index.php/pp/article/view/3229
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Evaluation of Pediatric Delirium in Saudi Arabian PICUs:A Comprehensive Assessment of Awareness and Management. Pharm Pract (Granada) [Internet]. 2025 Oct. 8 [cited 2025 Oct. 22];23(3):1-12. Available from: https://pharmacypractice.org/index.php/pp/article/view/3229