Prevalence, factors associated and immediate outcomes of delirium among children admitted at Acute Care Unit, Mulago National Referral Hospital
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Background: Delirium is one of the medical/psychiatric emergencies that is often unrecognized and undermanaged hence being associated with increased mortality and morbidity rates. Delirium is independently associated with prolonged length of hospital stay and adverse short term and long-term outcomes in children. Delirium can either be hyperactive, hypoactive or mixed. Early recognition of delirium, prevention and management is crucial to improve the overall condition of the child. General objective: To assess the prevalence, factors associated and immediate outcomes of delirium among children aged 6 months to 12 years admitted at Acute Care Unit in Mulago National Referral hospital. Methods: This was a cross sectional study carried out among 255 randomly selected children aged 6 months to 12 years admitted at Acute Care Unit, Mulago National Referral Hospital. The Richmond Agitation Sedation Scale (RASS) was used to screen the level of arousability in order to rule out deep sedation and agitation. For children with a RASS score of -4 and -5 which signifies deep sedation, they were excluded from the Cornell Assessment of Pediatric Delirium (CAPD) tool which was used to screen for delirium. The CAPD was used to screen the children twice daily, 10-12 hours apart. Children with a score of ≥9 at any one time were diagnosed as Delirious. The RASS score were further be used to subtype the type of delirium, hypoactive (0 to -3), hyperactive (0 to +4), mixed (score crossing 0, including both negative and positives). Data analysis was done in STATA version 16.0. Description of participants was done by summarizing the continuous variables into means and standard deviations and the categorical variables into frequencies and percentages. Associations between independent variables and delirium were assessed using modified regression reporting prevalence ratios along with their corresponding 95% confidence intervals. A P-value of <0.05 was taken for statistical significance. Study findings: The prevalence of delirium among the participating children was 29.8% (76/255), 95%CI 24.26 – 35.83. The 255 participating children had a median age 36 months. The majority (61.2%, 156/255) were male, giving a male: female ratio of 1.6:1 Having a neurologic disorder (aPR = 1.71, 95% 1.08 – 2.73, P value = 0.023) and having experienced developmental delay (aPR = 1.72, 95% 1.12 – 2.65, P value = 0.014) were associated with increased likelihood of delirium while being aged between 3 and 6 years (aPR = 0.56, 95% 0.33 - 0.94, P value = 0.029), having a caretaker with a tertiary level of education (aPR = 0.20, 95% 0.05 – 0.74, P value = 0.016) and being a 2nd born (aPR = 0.56, 95% 0.33 – 0.94, P value = 0.029) were associated with reduced likelihood of delirium. Of the 76 children found to be delirious, 1 child (1.3%) died within 72 hours while health workers had plans to discharge just half (53.9%) within 72 hours. Conclusions and recommendations: Paediatric delirium was a common complication among children admitted to the acute care unit, with a prevalence of 29.8%. Children with neurologic disorders and who had experienced developmental delay had increased prevalence of delirium Children aged 6 to 72 months were more likely to be delirious while those aged between 3years and above, whose caretakers had completed a tertiary level of education and 2ndborns were protected against delirium. The Ministry of Health should implement delirium screening in all acute care units especially among children aged below 3years, those with developmental delays and neurologic disorders to be able to improve admission outcomes such as reduced length of stay and reduced mortality.