Evaluation of pediatric delirium and iatrogenic withdrawal syndrome according to the Sophia Observation Withdrawal Symptoms and Pediatric Delirium-Scale in pediatric cardiac patients with prolonged sedation: an observational study

Abstract The objective of this prospective, observational study was the evaluation of the epidemiology of pediatric delirium (PD) and Iatrogenic Withdrawal Syndrome (IWS) in pediatric cardiac intensive care patients using the Sophia Observation Withdrawal Symptoms (SOS) and Pediatric Delirium (PD) scales. Occurrence of the IWS-PD syndrome, risk factors and short-term outcomes were analyzed. Children (3 months-16 years) admitted to the PCICU for > 48 h were included. We recorded a total of 3742 SOS and PD scores from 156 admissions. Each patient received a median of 12 assessments (4–56) for a median of 4 (2-23) days. Median peak PD scores were 7 (3-12), median peak SOS scores were 4 (2-7). Median duration of SOS score positivity was 3 days (1-6) and 3 days (2-7.7) for PD. Positive peak scores for both SOS and PD were simultaneously present in 76 children (50%). These patients were those with the highest severity of risk scores, the highest number of ventilation days, the longest sedation duration and PCICU admission. SOS (r:0.50, p < 0.0001) and PD (r:0.54, p = 0.0035) positivity was significantly correlated with PCICU length of stay, after multiple adjustments: SOS (OR 1.21, 95%CI 1.1 to 1.37, p = 0.0005) and PD (OR 1.38, 95% CI 1.176 to 1.685, p = 0.0009). Systematic use of the SOS-PD scales showed that about two thirds of patients experienced at least a positive assessment for abstinence or delirium, 50% of them experienced both simultaneously. SOS and PD severity is associated with PCICU length of stay.