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Psychiatry Newsletter - A Different Delirium

Hopkins BrainWise-Spring 2013

A Different Delirium

Date: April 15, 2013

Purple Watermelon

 “I wanted to see how we stand, clinically, at spotting delirium in children,” says child psychiatrist Patrick Kelly. “And the answer is, really bad.” 

While the necessity of treating delirium in adults is catching on (story, left), that hasn’t yet hit home in pediatrics nationwide, Kelly says. As in adults, there are problems of recognition. “We’ll get hospital calls to evaluate kids who suddenly become atypically anxious or aggressive,” he says. It’s fairly easy to spot  a child in the PICU who says—this  is an actual case—there’s a purple watermelon on my bed. But he and  colleague Emily Frosh note that usually, the phenomenon is more subtle in kids than adults.

“They come across as quiet and cute, when, in fact, they have no idea what’s going on around them. The delirium is missed entirely,” says Kelly.

So he and Frosh began documenting suspected instances when delirium was missed. A just-published study describes their review of records of 515 children referred, over eight years, for inpatient psychiatric consultation in The Johns Hopkins Hospital. Attention was paid to records with a diagnosis of delirium—or something close to it. Also, the two sifted computerized pediatric discharge records of roughly 64,000 kids during the same period.

The results? Pediatricians listed delirium only a tiny fraction of the time as a reason for sending children for a consult. And for the thousands of kids who’d passed through the hospital apparently without needing any such evaluation, the records say that only 0.1 percent of them had spent some time delirious. “We know that’s way out of line,” says Kelly.

What accounts most for the dramatic shortfall, he believes, “is not realizing how serious delirium is.” Not infrequently, it carries lingering cognitive effects and more serious implications for overall health. It isn’t a benign process “that just happens and is done with,” Kelly says.

“What hospitals need  most right now is  consciousness- raising.”

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