090 - A Novel Delirium Risk Screening Tool and Associated Delirium Occurrence in a Large Cardiac and Pulmonary Pre-Transplant Population

Publication Number: 90.3746

Chase Samsel, Boston Children's Hospital, Chestnut Hill, MA, United States; Cyanea YS Poon, Boston Children's Hospital, Boston, MA, United States; Imari-Ashley P.. Isaksen, Boston Children's Hospital, Boston, MA, United States; Beth Logan, Boston Children's Hospital, Boston, MA, United States

Background: Pediatric delirium is a complex neuropsychiatric syndrome that has increasingly been recognized in recent literature as an important entity in prognosis and outcomes. Validated intensive care unit screening tools have aided in recognition and diagnosis, but there is little to no research on tools and risk factors for delirium prior to hospitalization and intensive care and throughout the natural time course of pretransplant periods.

Objective: Our study aims to evaluate a novel delirium risk assessment (DRA) tool in predicting delirium occurrence and describing associated risk factors throughout the pretransplant to transplant period.

Design/Methods: We retrospectively reviewed charts of all patients receiving a psychological assessment for pre-transplant cardiac or pulmonary evaluation who were admitted to the cardiothoracic intensive care unit (CTICU) between 6/12/2019 and 3/5/2024. We compared items on the DRA with patients validated delirium screening tool scores, demographics, medical history including primary cardiopulmonary disease, significant medical interventions, ICU length of stay, use of deliriogenic medications, and length of time since pre-transplant evaluation.

Results: 246 unique pre-transplant patients were admitted to the CTICU with an average of 3 admissions each over the 4.5 year study period. 19% of the 246 patients died. 23% patients had yet to receive a transplant over the entire period. 52% of patients had not had a DRA despite standard implementation since April 2016, and 31% of patients with DRAs had known prior personal and/or family history of delirium. 63 of the 246 patients had both a DRA and a valid delirium screening score (“double-screened patients”) in the CTICU with 54% of them having a positive delirium finding. 29% of the double-screened patients who were delirious had prior histories of delirium on the DRA. Higher number of admissions was associated with delirium.

Conclusion(s): Delirium was common among pretransplant cardiopulmonary patients admitted to the intensive care unit. Pretransplant periods were often long, involved multiple admissions, had pretransplant psychological evaluations predating the DRA, and pretransplant periods often resulted in death. Patients screened with prior personal history of delirium had increased incidence of delirium in the hospital. The DRA can provide value in anticipatory guidance and planning that should be further evaluated in larger populations.