Point Prevalence of Pediatric Intensive Care Unit Delirium and Associated Risk Factors at Kenyatta National Hospital, Nairobi City County, Kenya

Abstract

Pediatric ICU delirium remains an understudied component in the provision of care to critically ill children that can lead to increased ICU stay, increased cost of care, and consequent debilitating post-discharge neurological deficits. Delirium is an acute disturbance of mental state presenting with reduced awareness of one’s environment and cognitive abilities. Screening for delirium remains essential for identifying risk factors and guiding management. The objective of the study was to determine the point prevalence of pediatric ICU delirium at Kenyatta National Hospital and to identify associated risk factors. The observational study was conducted over 17 weeks at Kenyatta National Hospital and included 51 patients, recruited at various time points. The observations began with sedation scoring using the Standard Richmond Agitation-Sedation Scale; patients who scored above -4 were then assessed using the Cornell Assessment of Pediatric Delirium Tool (CAPD). A score above 9 on the CAPD tool indicates delirium. Data from the questionnaire were collated in Microsoft Excel and exported to GraphPad Prism 10 for further analysis. In the Study, 71% (n = 51) of the patients presented with Delirium. The sex distribution showed that 20 participants (39.2%) were male and 31 (60.8%) were female. Mortality and mechanical ventilation are significantly associated with delirium (p = 0.013 and p = 0.019, respectively). This indicates the need for an adopted tool to screen children admitted to the intensive care unit for delirium, enabling early intervention.  There is also a need to strengthen clinical practice in the Pediatric Intensive Care Unit by adopting routine delirium screening. In terms of education and policy, delirium should be included in pediatric critical care training for both nurses and physicians.