Theresa A Scott

Delirium and sedation in the intensive care unit: survey of behaviors and attitudes of 1384 healthcare professionals.

Objective:A 2001 survey found that most healthcare professionals considered intensive care unit (ICU) delirium as a serious problem, but only 16% used a validated delirium screening tool. Our objective was to assess beliefs and practices regarding ICU delirium and sedation management. Design and Setting:Between October 2006 and May 2007, a survey was distributed to ICU practitioners in 41 North American hospitals, seven international critical care meetings and courses, and the American Thoracic Society e-mail database. Study Participants:A convenience sample of 1384 healthcare professionals including 970 physicians, 322 nurses, 23 respiratory care practitioners, 26 pharmacists, 18 nurse practitioners and physicians’ assistants, and 25 others. Results:A majority [59% (766 of 1300)] estimated that more than one in four adult mechanically ventilated patients experience delirium. More than half [59% (774 of 1302)] screen for delirium, with 33% of those respondents (258 of 774) using a specific screening tool. A majority of respondents use a sedation protocol, but 29% (396 of 1355) still do not. A majority (76%, 990 of 1309) has a written policy on spontaneous awakening trials (SATs), but the minority of respondents (44%, 446 of 1019) practice spontaneous awakening trials on more than half of ICU days. Conclusions:Delirium is considered a serious problem by a majority of healthcare professionals, and the percent of practitioners using a specific screening tool has increased since the last published survey data. Although most respondents have adopted specific sedation protocols and have an approved approach to stopping sedation daily, few report even modest compliance with daily cessation of sedation.

Family Report of ASD Concomitant with Depression or Anxiety Among US Children

The objective is to estimate prevalence of parent-reported depression or anxiety among children with ASD, and describe parental concerns for their children. The design is Analysis of National Survey of Children’s Health, 2003–2004. The participants are a national sample of 102,353 parents. 311,870 (544/100,000) parents of children ages 4–17 in the US reported that their child was diagnosed with autism. 125,809 also reported that their child had depression or anxiety (219/100,000). These parents report substantially higher concerns about their child’s self-esteem, academic success, and potential to be bullied. Clinicians should take into account that children with ASD may face increased risk of depression or anxiety in adolescence. Coordinated care addressing social and emotional health in addition to clinical attention is important in this population.

Effect of Anatomical and Developmental Factors on the Risk of Unplanned Extubation in Critically Ill Newborns

Objective To quantify the daily risk of unplanned extubation (UE) in newborns based on developmental and anatomical factors. Methods Prospective cohort of ventilated newborns over an 18‐month period in a level IV neonatal intensive care unit (NICU). We captured UEs through four data streams. We generated multivariable logistic regression models to assess the association of UE with chronological age, birth weight, and postmenstrual age. Results During the study, 718 infants were ventilated for 5,611 patient days with 117 UEs in 81 infants. The daily risk of UE had a significant, nonlinear relationship (p < 0.01) with chronological age, decreasing until day 7 (odds ratio [OR]: 0.5; 95% confidence interval [CI]: 0.17‐1.47) and increasing after day 7 (day 7‐28, OR: 1.36, 95% CI: 1.06‐1.75; and >28 days, OR: 1.06, 95% CI: 1.0‐1.14). Birth weight and postmenstrual age were not associated with UE. Adverse events occurred in 83/117 (71%) UE events. Iatrogenic causes of UE were more common in younger, smaller infants, whereas older, larger infants were more likely to self‐extubate. Conclusion The daily risk and causes of UE change over the course of an infants NICU hospitalization. These data can be used to identify infants at the highest risk of UE for whom targeted proactive interventions can be developed.

National and regional trends in gastrostomy in very low birth weight infants in the USA: 2000–2012

ObjectiveTo determine rates of gastrostomy (GT) in very low birth weight (VLBW) infants.Study designRetrospective, cross-sectional analysis of the Kids’ Inpatient Database for the years 2000, 2003, 2006, 2009 and 2012. We identified VLBW births and infants undergoing a GT, with and without fundoplication, using ICD-9-CM codes.ResultNational rates (per 1000 VLBW births) of GT increased from 11.5 GT (95% CI 10–13) in 2000 to 22.9 (95% CI 20–25) in 2012 (p < 0.001). Gastrostomy with and without fundoplication increased during the study period (p < 0.001 in both groups). VLBW survival also increased from 78.5% in 2000 to 81.1% in 2012 (p < 0.001). In all study years, the Northeast census region had the lowest GT rates, while the West had the highest rates in 4 of the 5 study years.ConclusionBetween 2000 and 2012, the incidence of GT in VLBW infants doubled, associated with improvements in survival in this population.