Delirium in Children Undergoing Hematopoietic Cell Transplantation: A Multi-Institutional Point Prevalence Study

Frontiers in Oncology

卷:11

Matthew P. Sharron¹  Kris M. Mahadeo¹  Jason L. Freedman²  Michelle P. Hudspeth³  Miriam C. Shapiro⁴  Caitlin Hurley⁴  Jennifer McArthur⁵  Matt S. Zinter⁶  Bruce M. Greenwald⁷  Farid Boulad⁸  Julie C. Fitzgerald⁹  Linda M. Gerber¹⁰  Yogi Raj Chopra¹¹  Christine N. Duncan¹²  Larisa Broglie¹³  Chani Traube¹⁴  Donna A. Wall¹⁵  Christen L. Ebens¹⁵  Keshia Small¹⁶  Gabrielle Silver¹⁶  Elizabeth A. Mauer¹⁷ 

[1] Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, United States;

[2] 0Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States;

[3] 1Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States;

[4] 2Department of Bone Marrow Transplant &

[5] 3Department of Stem Cell Transplantation and Cellular Therapy, Children's Cancer Hospital, University of Texas at MD Anderson Cancer Center, Houston, TX, United States;

[6] 4Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, United States;

[7] 5Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States;

[8] 6Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States;

[9] Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States;

[10] Department of Medicine, Weill Cornell Medical College, New York, NY, United States;

[11] Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada;

[12] Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston, MA, United States;

[13] Department of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Medical Center, New York, NY, United States;

[14] Department of Pediatrics, MSK Kids at Memorial Sloan Kettering Cancer Center, New York, NY, United States;

[15] Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States;

[16] Department of Pediatrics, Weill Cornell Medical College, New York, NY, United States;

[17] Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States;

关键词: cancer;    pediatric oncology;    hematopoietic cell transplant;    delirium;    cornell assessment of pediatric delirium;    incidence;   

DOI  :  10.3389/fonc.2021.627726

来源: DOAJ

【 摘 要 】

Introduction: Delirium occurs frequently in adults undergoing hematopoietic cell transplantation, with significant associated morbidity. Little is known about the burden of delirium in children in the peri-transplant period. This study was designed to determine delirium rates, define risk factors (demographic and treatment related), and establish feasibility of multi-institutional bedside screening for delirium in children undergoing hematopoietic cell transplant.Methods: This is a multi-institutional point prevalence study. All subjects were prospectively screened for delirium twice daily using the Cornell Assessment of Pediatric Delirium over a 10-day period. De-identified data, including basic demographics and daily characteristics, were extracted from the electronic medical record.Results: Eleven North American institutions were included, 106 children were enrolled, and 883 hospital days were captured. Delirium screening was successfully completed on more than 98% of the study days. Forty-eight children (45%) developed delirium over the course of the 10-day study. Children were diagnosed with delirium on 161/883 study days, for an overall delirium rate of 18% per day. Higher delirium rates were noted in children <5 years old (aOR 0.41 for children over 5 years), and in association with specific medications (melatonin, steroids, and tacrolimus).Conclusion: Delirium was a frequent occurrence in our study cohort, with identifiable risk factors. Delirium screening is highly feasible in the pediatric hematopoietic cell transplant patient population. A large-scale prospective longitudinal study following children throughout their transplant course is urgently needed to fully describe the epidemiology of pediatric delirium, explore the effects of delirium on patient outcomes, and establish guidelines to prevent and treat delirium in the peri-transplant period.

【 授权许可】

Unknown