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Delirium documentation in hospitalized pediatric patients with cancer

Published online by Cambridge University Press:  01 March 2021

Kelly Lastrapes ,
Malisa Dang Open the ORCID record for Malisa Dang [Opens in a new window] ,
J. Brian Cassel ,
Tamara Orr ,
Tracye Proffitt  and
Egidio Del Fabbro
Kelly Lastrapes
Affiliation:
Pediatric Hematology, Oncology and Palliative Care, Department of Pediatrics, Division of Pediatric Hematology/Oncology, Virginia Commonwealth University, Richmond, VA, USA
Malisa Dang
Affiliation:
Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, USA
J. Brian Cassel
Affiliation:
Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, USA
Tamara Orr
Affiliation:
Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, USA
Tracye Proffitt
Affiliation:
Department of Adult Health and Nursing Systems, Virginia Commonwealth University, Richmond, VA, USA
Egidio Del Fabbro*
Affiliation:
Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, USA
*
Author for correspondence: Egidio Del Fabbro, Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, USA. E-mail: [email protected]
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Abstract

Objective

Screening tools for delirium are being used more consistently in pediatric critical care. However, screening is not universal, and delirium may be underdiagnosed, misdiagnosed, or undocumented in hospitalized patients. We evaluated the identification and documentation of delirium in pediatric oncology and bone marrow transplant patients.

Method

A retrospective chart review on all hospitalized pediatric oncology and bone marrow transplant patients admitted to an Academic Cancer center between 2013 and 2016. Patients aged less than 21 years of age with active cancer were included. Patients with major psychiatric conditions, developmental delays, or autism were excluded. Data were collected to characterize documentation concerning the identification and diagnosis of delirium.

Results

Of 201 hospitalization records, 54 (26.9%) admissions from 109 unique patients had documentation of delirium. The overall documented incidence of delirium was 3.2% of hospitalizations or 8.2% of unique patients. Patients prescribed opioids and benzodiazepines were more likely to have documentation of delirium. ICD coding under-reported delirium while physician documentation was inaccurate in 26% (53/201) when compared with the chart review.

Significance of results

Delirium was frequently undocumented or miscoded. Implementing a validated, universal screening tool for delirium may improve identification and clinical outcomes.

Keywords

DeliriumDocumentation and ICD coding for deliriumPediatric oncology
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 3 , June 2021 , pp. 283 - 286
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

*

These authors contributed equally to this work.

References

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