Child Psychiatry Engagement in the Management of Delirium in Critically Ill Children

OBJECTIVES: To characterize the engagement of child psychiatry by pediatric intensivists in cases of suspected delirium in a pediatric intensive care unit (PICU) prior to implementation of a delirium management algorithm with regards to recommendations, antipsychotic prescribing, and follow-up after PICU discharge. DESIGN: Retrospective chart review. SETTING: Single-center tertiary PICU. SUBJECTS: Sixteen patients who received child psychiatry consultation for suspected delirium while in the PICU. MEASUREMENTS AND MAIN RESULTS: Child psychiatry was consulted for 50 patients in the PICU during the 2-year period. Sixteen (32%) of these consultations were for delirium, and 15 (94%) of these patients were diagnosed with hyperactive delirium. Eighty-one percent of the patients were prescribed an antipsychotic, and over half of these patients had been initiated on the antipsychotic prior to child psychiatry consultation. All patients who transitioned from the PICU to the general floor received child psychiatry follow-up. CONCLUSIONS: Child psychiatry can play an integral role in collaborative management of PICU delirium. Continuity of care with child psychiatry after transfer or discharge is particularly important given the prevalence of antipsychotic use. Furthermore, the results of this retrospective study would suggest that staff education surrounding the delirium screening tool increased awareness of delirium, resulting in an increase in child psychiatry consultations.