Objective To investigate the risk factors for delirium after sedation in children with convulsion, and to establish a nomogram model for predicting the risk of delirium. Methods A total of 373 children with convulsion who were hospitalized in the pediatric ward of the Second Affiliated Hospital of Air Force Medical University from August 2020 to January 2022 were prospectively enrolled. There were 245 children in the modeling group and 128 children in the validation group. A multivariate logistic regression analysis was used to identify independent predictive factors for delirium after sedation and establish a nomogram model for predicting the risk of this disorder based on these factors. The calibration curve, the receiver operating characteristic curve, and the decision curve analysis were used to evaluate the accuracy, discriminatory ability, and clinical application value of this model, respectively. Results The incidence of delirium after sedation was 22.3% (83/373) in the children with convulsion. The multivariate logistic regression analysis showed that age>5 years (OR=0.401, P<0.05) was a protective factor against delirium after sedation in these children, while presence of infection (OR=3.020, P<0.05), admission to the pediatric intensive care unit (OR=3.126, P<0.05), use of benzodiazepines (OR=5.219, P<0.05), history of status convulsion (OR=2.623, P<0.05), and history of delirium episodes (OR=3.119, P<0.05) were risk factors for delirium. The H-L deviation test of the nomogram prediction model showed a good degree of fit (χ2=9.494, P=0.302). Internal and external validation showed that the mean absolute errors between the actual and predicted values of the calibration curve were 0.030 and 0.018, respectively, and the areas under the receiver operating characteristic curve were 0.777 and 0.775, respectively. The decision curve analysis showed that the model provided significant net clinical benefit when the predicted risk threshold was >0.01. Conclusions Age, presence of infection, admission to the pediatric intensive care unit, use of benzodiazepines, history of status convulsion, and history of delirium episodes are closely associated with the development of delirium after sedation in children with convulsion. The nomogram model for predicting this disorder that is established based on these factors has relatively high accuracy, discriminatory ability, and clinical application value.
Key words
Delirium /
Convulsion /
Sedation /
Risk factor /
Nomogram model /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
1 Fine A, Wirrell EC. Seizures in children[J]. Pediatr Rev, 2020, 41(7): 321-347. PMID: 32611798. DOI: 10.1542/pir.2019-0134.
2 王卫平, 孙锟, 常立文. 儿科学[M]. 9版. 北京: 人民卫生出版社, 2018: 374-377.
3 Laino D, Mencaroni E, Esposito S. Management of pediatric febrile seizures[J]. Int J Environ Res Public Health, 2018, 15(10): 2232. PMID: 30321985. PMCID: PMC6210946. DOI: 10.3390/ijerph15102232.
4 Page VJ. Does sedation related delirium matter?[J]. Lancet Respir Med, 2018, 6(3): 167-168. PMID: 29508701. DOI: 10.1016/S2213-2600(18)30067-5.
5 付聪慧, 徐婷婷, 杨晓亚, 等. 危重症患儿谵妄相关危险因素及护理干预的研究进展[J]. 现代临床护理, 2021, 20(5): 61-66. DOI: 10.3969/j.issn.1671-8283.2021.05.010.
6 Traube C, Mauer EA, Gerber LM, et al. Cost associated with pediatric delirium in the ICU[J]. Crit Care Med, 2016, 44(12): e1175-e1179. PMID: 27518377. PMCID: PMC5592112. DOI: 10.1097/CCM.0000000000002004.
7 颜艳, 王彤. 医学统计学[M]. 5版. 北京: 人民卫生出版社, 2020: 507, 569-578.
8 Dervan LA, Di Gennaro JL, Farris RWD, et al. Delirium in a tertiary PICU: risk factors and outcomes[J]. Pediatr Crit Care Med, 2020, 21(1): 21-32. PMID: 31568239. DOI: 10.1097/PCC.0000000000002126.
9 Alvarez RV, Palmer C, Czaja AS, et al. Delirium is a common and early finding in patients in the pediatric cardiac intensive care unit[J]. J Pediatr, 2018, 195: 206-212. PMID: 29395177. DOI: 10.1016/j.jpeds.2017.11.064.
10 Meyburg J, Dill ML, von Haken R, et al. Risk factors for the development of postoperative delirium in pediatric intensive care patients[J]. Pediatr Crit Care Med, 2018, 19(10): e514-e521. PMID: 30059477. DOI: 10.1097/PCC.0000000000001681.
11 Traube C, Silver G, Gerber LM, et al. Delirium and mortality in critically ill children: epidemiology and outcomes of pediatric delirium[J]. Crit Care Med, 2017, 45(5): 891-898. PMID: 28288026. PMCID: PMC5392157. DOI: 10.1097/CCM.0000000000002324.
12 Ricardo Ramirez C, álvarez Gómez ML, Agudelo Vélez CA, et al. Clinical characteristics, prevalence, and factors related to delirium in children of 5 to 14 years of age admitted to intensive care[J]. Med Intensiva (Engl Ed), 2019, 43(3): 147-155. PMID: 29530328. DOI: 10.1016/j.medin.2018.01.013.
13 Holly C, Porter S, Echevarria M, et al. CE: original research: recognizing delirium in hospitalized children: a systematic review of the evidence on risk factors and characteristics[J]. Am J Nurs, 2018, 118(4): 24-36. PMID: 29543606. DOI: 10.1097/01.NAJ.0000532069.55339.f9.
14 Kalvas LB, Harrison TM. State of the science in pediatric ICU delirium: an integrative review[J]. Res Nurs Health, 2020, 43(4): 341-355. PMID: 32632985. PMCID: PMC8006059. DOI: 10.1002/nur.22054.
15 Patel AK, Biagas KV, Clarke EC, et al. Delirium in children after cardiac bypass surgery[J]. Pediatr Crit Care Med, 2017, 18(2): 165-171. PMID: 27977539. PMCID: PMC5658045. DOI: 10.1097/PCC.0000000000001032.
16 Silver G, Traube C, Kearney J, et al. Detecting pediatric delirium: development of a rapid observational assessment tool[J]. Intensive Care Med, 2012, 38(6): 1025-1031. PMID: 22407142. DOI: 10.1007/s00134-012-2518-z.
17 何珊, 王亚力, 左泽兰. 中文版康奈尔儿童谵妄量表的临床初步应用[J]. 中华儿科杂志, 2019, 57(5): 344-349. PMID: 31060126. DOI: 10.3760/cma.j.issn.0578-1310.2019.05.006.
18 何珊, 左泽兰, 许峰. 儿童谵妄的防治[J]. 中国小儿急救医学, 2020, 27(2): 86-91. DOI: 10.3760/cma.j.issn.1673-4912.2020.02.003.
19 Schieveld JN, Leroy PL, van Os J, et al. Pediatric delirium in critical illness: phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit[J]. Intensive Care Med, 2007, 33(6): 1033-1040. PMID: 17457571. PMCID: PMC1915613. DOI: 10.1007/s00134-007-0637-8.
20 Norman S, Taha AA, Turner HN. Delirium in the critically ill child[J]. Clin Nurse Spec, 2017, 31(5): 276-284. PMID: 28806234. DOI: 10.1097/NUR.0000000000000324.
21 Smith HA, Gangopadhyay M, Goben CM, et al. The preschool confusion assessment method for the ICU: valid and reliable delirium monitoring for critically ill infants and children[J]. Crit Care Med, 2016, 44(3): 592-600. PMID: 26565631. PMCID: PMC4764386. DOI: 10.1097/CCM.0000000000001428.
22 Mattison MLP. Delirium[J]. Ann Intern Med, 2020, 173(7): ITC49-ITC64. PMID: 33017552. DOI: 10.7326/AITC202010060.
23 Atterton B, Paulino MC, Povoa P, et al. Sepsis associated delirium[J]. Medicina (Kaunas), 2020, 56(5): 240. PMID: 32443606. PMCID: PMC7279289. DOI: 10.3390/medicina56050240.
24 成怡冰, 李倩影, 钱素云. PICU患儿的睡眠障碍[J]. 中国小儿急救医学, 2020, 27(2): 101-104. DOI: 10.3760/cma.j.issn.1673-4912.2020.02.006.
25 Mody K, Kaur S, Mauer EA, et al. Benzodiazepines and development of delirium in critically ill children: estimating the causal effect[J]. Crit Care Med, 2018, 46(9): 1486-1491. PMID: 29727363. PMCID: PMC6095819. DOI: 10.1097/CCM.0000000000003194.
26 中华医学会儿科学分会神经学组. 热性惊厥诊断治疗与管理专家共识(2017实用版)[J]. 中华实用儿科临床杂志, 2017, 32(18): 1379-1382. DOI: 10.3760/cma.j.issn.2095-428X.2017.18.005.
27 Pasin L, Febres D, Testa V, et al. Dexmedetomidine vs midazolam as preanesthetic medication in children: a meta-analysis of randomized controlled trials[J]. Paediatr Anaesth, 2015, 25(5): 468-476. PMID: 25559766. DOI: 10.1111/pan.12587.
28 Pujar S, Scott RC. Long-term outcomes after childhood convulsive status epilepticus[J]. Curr Opin Pediatr, 2019, 31(6): 763-768. PMID: 31693585. DOI: 10.1097/MOP.0000000000000825.
29 Gorter JA, van Vliet EA, Aronica E. Status epilepticus, blood-brain barrier disruption, inflammation, and epileptogenesis[J]. Epilepsy Behav, 2015, 49: 13-16. PMID: 25958228. DOI: 10.1016/j.yebeh.2015.04.047.
30 Hatherill S, Flisher AJ. Delirium in children and adolescents: a systematic review of the literature[J]. J Psychosom Res, 2010, 68(4): 337-344. PMID: 20307700. DOI: 10.1016/j.jpsychores.2009.10.011.
31 何珊, 左泽兰. 镇静镇痛状态下危重症患儿谵妄评估研究进展[J]. 中华危重症医学杂志(电子版), 2018, 11(1): 55-59. DOI: 10.3877/cma.j.issn.1674-6880.2018.01.010.
32 杨桂凤, 虞敏亚, 杨雪兰. 个体化预测早期消化道肿瘤ESD术后迟发性出血风险的列线图模型的建立[J]. 中华现代护理杂志, 2021, 27(2): 164-170. DOI: 10.3760/cma.j.cn115682-20200515-03365.
33 董瑶, 宋玲. 主动脉手术患者术中压力性损伤Nomogram预测模型的建立[J]. 中华现代护理杂志, 2021, 27(18): 2453-2458. DOI: 10.3760/cma.j.cn115682-20210126-00403.
34 Van Calster B, Wynants L, Verbeek JFM, et al. Reporting and interpreting decision curve analysis: a guide for investigators[J]. Eur Urol, 2018, 74(6): 796-804. PMID: 30241973. PMCID: PMC6261531. DOI: 10.1016/j.eururo.2018.08.038.
PDF(780 KB)
