Delirium in Paediatric Burn Patients: A PICU Case Series

Ms Rebecca Paterson1, Professor Justin Kenardy1, Dr Alexandra De Young3, Dr Debbie Long4, Dr Belinda Dow2, Professor Roy Kimble3

1School of Psychology, University Of Queensland, South Brisbane, Australia, 2RECOVER Injury Research Centre, Herston, Australia, 3Centre for Children’s Burn and Trauma Research, South Brisbane, Australia, 4Paediatric Critical Care Research Group, South Brisbane, Australia

Background: In adult burns patients, delirium is a common and serious complication of a burn injury, with 77 percent of patients with burn injuries diagnosed with delirium in the Intensive Care Unit (ICU).  Factors such as age, ventilation status, benzodiazepine administration, and surgical requirements have been linked to an increased risk of delirium. No literature currently explores delirium in patients admitted to the Paediatric Intensive Care Unit (PICU) for burn injuries, however.

Methods: 10 patients admitted to the PICU of Lady Cilento Children’s Hospital for burn injuries over 12 months were prospectively reviewed based on their medical information and delirium status.

Results: Delirium was present in 9 out 10 patients.  Positive indications of delirium were correlated with younger age (r(s) = -.76, p  = .011) and sedation administration, specifically diazepam, methadone and clonidine. Delirium was not correlated with TBSA, Injury Severity or Length of Stay (LOS).

Conclusions: It is clear that paediatric patients with burn injuries do experience delirium, and may be more at risk if they are younger or are receiving doses of clonidine, methadone and diazepam.  Early results also highlight the value in bedside nurses in identifying symptoms of delirium. Other factors, such as TBSA, Injury Severity and LOS may also be related to experiencing delirium, but was not evident in this sample. Caution should be drawn interpreting these results due to the small sample size, but these preliminary results highlight the need for further research into delirium in PICU patients with burn injuries.

Rebecca is a PhD Student with the University of Queensland’s School of Psychology. She is based in the Paediatric Intensive Care Unit at the Lady Cilento Children’s Hospital and is currently investigating what contributes to a child’s risk of developing delirium, how delirium can be best screened, and whether delirium impacts a child’s recovery once they are discharged.

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