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Stenkjaer RL, Egerod I, Moszkowicz M, Ista E, Greisen G, Weis J, Pagsberg AK, Herling SF. Prospective validation of Sophia observation withdrawal symptoms: A paediatric delirium scale in critically ill children in Denmark. Aust Crit Care 2024; 37:400-406. [PMID: 37164889 DOI: 10.1016/j.aucc.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Paediatric delirium (PD) is increasingly recognised as a common disorder in critically ill children with a reported prevalence ranging from 9% to 66%. We validated the PD component of the Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale in a Danish setting to provide increased awareness and reliable identification of this critical condition, thereby paving the way for improved pathways to targeted delirium care. OBJECTIVE The objectives of this study were to criterion validate the PD component of the SOS-PD screening tool by comparing blinded psychiatric and nurse assessments and to estimate the prevalence of delirium in critically ill children in a Danish context. METHODS A prospective observational study was performed on critically ill children aged between 3 m and 18 y, admitted to an intensive care unit, with a hospital stay of 48 h or more. Assessments took place on a fixed weekday over an 18-month period. To test accuracy and criterion validity, bedside nurses' SOS-PD assessments were compared to the reference standard, a diagnostic assessment performed by a child psychiatrist according to the Diagnostic and Statistical Manual-V criteria by use of the Vanderbilt Assessment of Delirium in Infants and Children. RESULTS We included 141 children in the study, 30 (21%) of whom were diagnosed with delirium by the child psychiatrist. The accuracy of the delirium diagnosis was 93.6% (95% confidence interval [CI]: 88.3-97.1) among the nurses' SOS-PD assessments compared to the reference standard. The SOS-PD demonstrated a high sensitivity of 83.3% (95% CI: 65.3-94.4) and a high specificity of 96.4% (95% CI: 91.0-99.0) with five false-negative and four false-positive cases. CONCLUSION The PD component of the SOS-PD tool has good accuracy and validity for assessments performed by nurses compared to a child psychiatrist's diagnosis in critically ill children in a Danish setting. We recommend the use of the SOS-PD instrument in clinical practice.
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Affiliation(s)
- Rikke Louise Stenkjaer
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark; University of Copenhagen, Department of Clinical Medicine Copenhagen, Denmark.
| | - Mala Moszkowicz
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, Copenhagen 2900 Hellerup, Denmark.
| | - Erwin Ista
- Department of paediatric Surgery, paediatric Intensive Care, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark; University of Copenhagen, Department of Clinical Medicine Copenhagen, Denmark.
| | - Janne Weis
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, Copenhagen 2900 Hellerup, Denmark.
| | - Suzanne Forsyth Herling
- The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark; University of Copenhagen, Department of Clinical Medicine Copenhagen, Denmark.
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Stenkjaer RL, Egerod I, Moszkowicz M, Collet MO, Weis J, Ista E, Greisen G, Herling SF. The parent perspective on paediatric delirium and an associated care bundle: A qualitative study. J Adv Nurs 2024. [PMID: 38186225 DOI: 10.1111/jan.16048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
AIMS To explore how parents experienced their child with delirium and how parents viewed our delirium management bundle. DESIGN We conducted a qualitative exploratory descriptive study using semi-structured individual or dyad interviews. METHODS Twelve semi-structured interviews with 16 parents of 12 critically ill children diagnosed with delirium in a paediatric intensive care unit were conducted from October 2022 to January 2023 and analysed through a reflexive thematic analysis. FINDINGS We generated five themes: (1) knowing that something is very wrong, (2) observing manifest changes in the child, (3) experiencing fear of long-term consequences, (4) adding insight to the bundle, and (5) family engagement. CONCLUSION The parents in our study were able to observe subtle and manifest changes in their child with delirium. This caused fear of lasting impact. The parents regarded most of the interventions in the delirium management bundle as relevant but needed individualization in the application. The parents requested more information regarding delirium and a higher level of parent engagement in the care of their child during delirium. IMPACT This paper contributes to understanding how parents might experience delirium in their critically ill child, how our delirium management bundle was received by the parents, and their suggestions for improvement. Our study deals with critically ill children with delirium, their parents, and staff working to prevent and manage paediatric delirium (PD) in the paediatric intensive care unit. REPORTING METHOD The consolidated criteria for reporting qualitative research guidelines were used to ensure the transparency of our reporting. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution to the research design. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL COMMUNITY?: - It increases awareness of the parent's perspective on PD in critically ill children. - It shows how PD might affect parents, causing negative emotions such as distress, frustration, and fear of permanent damage. - It shows that the parents in our study, in addition to the care bundle, requested more information on delirium and more involvement in the care of their delirious child.
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Affiliation(s)
- Rikke Louise Stenkjaer
- Department of Intensive Care for Infants and Toddlers, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mala Moszkowicz
- Child and Adolescent Mental Health, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marie Oxenbøll Collet
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Janne Weis
- Department of Intensive Care for Infants and Toddlers, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Erwin Ista
- Division of Pediatric Intensive Care, Department of Neonatal and Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gorm Greisen
- Department of Intensive Care for Infants and Toddlers, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Suzanne Forsyth Herling
- Department of Neuroanaesthesiology, Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Galuszka JE, Thomsen K, Knudsen JD, Stenkjaer RL, Nielsen R, Nielsen KL, Petersen A, Holzknecht BJ, Damkjaer Bartels M, Breindahl M, Aunsholt L. Risk factors for methicillin-resistant Staphylococcus aureus colonization in a level-IV neonatal intensive care unit: a retrospective study. Antimicrob Steward Healthc Epidemiol 2023; 3:e194. [PMID: 38028927 PMCID: PMC10654989 DOI: 10.1017/ash.2023.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023]
Abstract
Objective To identify risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) colonization in neonatal patients during an MRSA outbreak to minimize future outbreaks. Design Retrospective case-control study. Setting Level-IV neonatal intensive care unit (NICU) at Copenhagen University Hospital, Rigshospitalet, Denmark. Patients Neonates with either MRSA or methicillin-susceptible Staphylococcus aureus (MSSA). Methods Methicillin-resistant Staphylococcus aureus-positive neonates were matched with those colonized or infected with MSSA in a 1:1 ratio. The control group was selected from clinical samples, whereas MRSA-positive neonates were identified from clinical samples or from screening. A total of 140 characteristics were investigated to identify risk factors associated with MRSA acquisition. The characteristics were categorized into three categories: patient, unit, and microbiological characteristics. Results Out of 1,102 neonates screened for MRSA, between December 2019 and January 2022, 33 were MRSA positive. They were all colonized with an MRSA outbreak clone (spa type t127) and were included in this study. Four patients (12%) had severe infection. Admission due to respiratory diseases, need for intubation, need for peripheral venous catheters, admission to shared rooms with shared toilets and bath facilities in the aisles, and need for readmission were all correlated with later MRSA colonization (P < 0.05). Conclusion We identified clinically relevant diseases, procedures, and facilities that predispose patients to potentially life-threatening MRSA infections. A specific MRSA reservoir remains unidentified; however, these findings have contributed to crucial changes in our NICU to reduce the number of MRSA infections and future outbreaks.
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Affiliation(s)
- Julia Elzbieta Galuszka
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kim Thomsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rikke Louise Stenkjaer
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rikke Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Karen Leth Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Barbara Juliane Holzknecht
- Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Damkjaer Bartels
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Morten Breindahl
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lise Aunsholt
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
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Stenkjaer RL, Egerod I, Moszkowicz M, Greisen G, Ista E, Herling SF, Weis J. Clinical application of 'Sophia Observation withdrawal Symptoms-Paediatric Delirium' screening tool in Danish version: A feasibility study. Scand J Caring Sci 2022; 36:1027-1036. [PMID: 35253260 PMCID: PMC9790259 DOI: 10.1111/scs.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/29/2022] [Accepted: 02/22/2022] [Indexed: 12/30/2022]
Abstract
AIMS AND OBJECTIVES The aims of the present study were investigating the feasibility of: (1) using the Danish version of Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) screening tool in clinical practice and (2) comparing SOS-PD performance to a child psychiatrist's assessment using the diagnostic criteria as a reference standard. BACKGROUND Critically ill children risk developing delirium potentially causing discomfort and suffering. Intensive care delirium has a fluctuating course complicating detection. Systematic screening during and after intensive care is central to manage paediatric delirium. DESIGN AND METHODS We used a descriptive and comparative design. First aim: Bedside nurses were asked to evaluate their experience of using the SOS-PD. Second aim: We compared the SOS-PD performance with the child psychiatrist assessment in 50 children aged 4 weeks to 18 years. RESULTS Nurses found the Danish version of the SOS-PD applicable and easy to use. Of the 50 children included, 13 were diagnosed with delirium by the child psychiatrist. Consistency was found between the SOS-PD score and the child psychiatrist's assessment (88%). We found three false-negative and three false-positive SOS-PD cases. The false-negative cases could be explained by the differences in time periods for the assessments. SOS-PD assessments covered the past 4 h, whereas the psychiatric assessments covered the past 24 h. We assume the false-positive cases represent an acceptable inconsistency between the two assessment methods. CONCLUSIONS The Danish version of the SOS-PD appeared suitable for identifying paediatric delirium. Our results emphasised the importance of assessment at least once during each nursing shift to ensure delirium detection around the clock due to the fluctuating course of delirium. RELEVANCE TO CLINICAL PRACTICE Implementing the Danish SOS-PD may increase awareness of this critical disorder by improving systematic identification of paediatric delirium in clinical practice paving the way for improved delirium prevention and management.
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Affiliation(s)
| | - Ingrid Egerod
- Department of Intensive CareCopenhagen University Hospital RigshospitaletCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Mala Moszkowicz
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark,Research Unit at Child and Adolescent Mental Health CenterCapital Region of DenmarkCopenhagenDenmark
| | - Gorm Greisen
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark,Department of Neonatology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Erwin Ista
- Department of Pediatric SurgeryPediatric Intensive CareErasmus MC – Sophia Children’s HospitalRotterdamthe Netherlands
| | | | - Janne Weis
- Department of NeonatologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
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Stenkjaer RL, Herling SF, Egerod I, Weis J, van Dijk M, Kudchadkar SR, Ramelet AS, Ista E. Development of a non-pharmacologic delirium management bundle in paediatric intensive care units. Nurs Crit Care 2022; 27:867-876. [PMID: 35726841 PMCID: PMC10084175 DOI: 10.1111/nicc.12809] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-pharmacologic interventions might be effective to reduce the incidence of delirium in pediatric intensive care units (PICU). AIM To explore expert opinions and generate informed consensus decisions regarding the content of a non-pharmacologic delirium bundle to manage delirium in PICU patients. STUDY DESIGN A two-round online Delphi study was conducted from February to April 2021. PICU experts (nurses, physicians, researchers, physical therapists, play specialists, and occupational therapists) located in Europe, North America, South America, Asia, and Australia participated. RESULTS We developed a questionnaire based on the outcomes of a comprehensive literature search in the domains: 1) cognition support; 2) sleep support; and 3) physical activity support. Under these domains, we listed 11 strategies to promote support with 61 interventions. Participants rated the feasibility of each intervention on a 9-point Likert scale (ranging from 1 strongly disagree to 9 strongly agree). A disagreement index and panel median were calculated to determine the level of agreement among experts. In the second round, participants reassessed the revised statements and ranked the interventions in each domain in order of importance for age groups: 0-2, 3-5, and 6-18 years of age. During the first Delphi round, 53 of 74 (72%) questionnaires were completed, and in the second round 45 of 74 (61%) were completed. Five of the highest ranked interventions across the age groups were: 1) developing a daily routine, 2) adjusting light exposure according to the time of day, 3) scheduling time for sleep, 4) providing eyeglasses and hearing aids if appropriate, 5) encouraging parental presence. CONCLUSIONS Based on expert consensus, we developed an age-specific non-pharmacologic delirium bundle of interventions to manage delirium in PICU patients. RELEVANCE TO CLINICAL PRACTICE An age-specific Non-Pharmacological Delirium bundle is now ready to be tested in the PICU and will hopefully reduce pediatric delirium.
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Affiliation(s)
- Rikke Louise Stenkjaer
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Janne Weis
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Monique van Dijk
- Department of Pediatric Surgery, Pediatric Intensive care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Sapna Ravi Kudchadkar
- Anesthesiology & Critical Care Medicine, Pediatrics, and Physical Medicine & Rehabilitation, Associate Vice Chair for Research, ACCM, Johns Hopkins University School of Medicine, Charlotte Bloomberg Children's Center, Baltimore, Maryland, USA
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland.,Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Erwin Ista
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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