The occurrence of delirium diagnosis among youth hospitalizations in the United States: A Kids' Inpatient Database analysis

OBJECTIVES

Delirium is an acute neuropsychiatric condition associated with increased morbidity and mortality. There is increasing recognition of delirium as a substantial health burden in younger patients, although few studies have characterized its occurrence. This study analyzes the occurrence of delirium diagnosis, its comorbidities, and cost among youth hospitalized in the United States.

METHODS

The Kids' Inpatient Database, a national all-payers sample of pediatric hospitalizations in general hospitals, was examined for the year 2019. Hospitalizations with a discharge diagnosis of delirium among patients aged 1-20 years were included in the analysis.

RESULTS

Delirium was diagnosed in 43,138 hospitalizations (95% CI: 41,170-45,106), or 2.3% of studied hospitalizations. Delirium was diagnosed in a broad range of illnesses, with suicide and self-inflicted injury as the most common primary discharge diagnosis among patients with delirium. In-hospital mortality was seven times greater in hospitalizations caring a delirium diagnosis. The diagnosis of delirium was associated with an adjusted increased hospital cost of $8648 per hospitalization, or $373 million in aggregate cost.

CONCLUSIONS

Based on a large national claims database, delirium was diagnosed in youth at a lower rate than expected based on prospective studies. The relative absence of delirium diagnosis in claims data may reflect underdiagnosis, a failure to code, and/or a lower rate of delirium in general hospitals compared with other settings. Further research is needed to better characterize the incidence and prevalence of delirium in young people in the hospital setting.

Our House Is on Fire: Child and Adolescent Psychiatrists in the Era of the Climate Crisis

The global climate crisis has arrived and is impacting pediatric mental health in the form of children facing more frequent and severe weather-related trauma, experiencing climate-related deprivation and displacement, and experiencing anxiety and grief related to inevitable losses to come. Child and adolescent psychiatrists must respond: we are care providers to individuals and families in distress; we are contributors to the crisis through our own emissions; and we are potential mediators of the crisis, somewhat uniquely, as we work to instill agency and hope.

Prescribing Patterns in a Psychiatrically Referred Sample of Youth With Autism Spectrum Disorder

OBJECTIVE

The aim of this study was to examine the pattern of psychopharmacologic interventions in a psychiatrically referred sample of youth with autism spectrum disorder (ASD).

METHODS

This retrospective chart review aimed at collecting demographic and clinical information, including data on DSM-IV-TR criteria-based psychiatric disorders and related current medication treatment and response. Data were collected in December 2011. Clinicians identified the target disorder for each medication and any adverse events. Level of psychopathology and therapeutic response was assessed by the clinician-rated Clinical Global Impressions scale (CGI).

RESULTS

Psychiatrically referred youth with ASD (n = 54) suffered from multiple psychopathologies (mean = 2.3) and had a marked level of morbidity (range of baseline CGI-Severity of Illness mean scores, 4.3-5.6). The most prevalent psychopathology was ADHD (83%), anxiety disorders (67%), bipolar spectrum disorder (43%), and mood disorder not otherwise specified (44%). The majority (80%) of the subjects received combination therapy (mean ± SD number of psychotropic medications = 3 ± 1.5). Forty percent of the participants responded on all treatment target symptoms (CGI-Improvement scale score ≤ 2), and an additional 10% experienced response versus nonresponse on a relatively greater number of target symptoms. Half of the subjects reported an adverse event, most commonly weight gain (28%) and sedation (12%), both from antipsychotic medication use.

CONCLUSIONS

Psychiatrically referred youth with ASD suffer from multiple highly impairing psychiatric disorders that require combination pharmacotherapy. These findings highlight the need for further research to guide clinical decision-making and treatment.

Television system for the measurement of atmospheric OTF degradation

A television system utilizing videotape recorder storage is used to store a large number of images degraded by the atmosphere. By using a large number of samples one can obtain an accurate value for the system-atmosphere MTF. The measured transfer functions are in agreement with Fried's analysis, and the values for the index of refraction structure constant are comparable with those obtained from scintillation measurements.