Fall Risk for Delirium Patients in Pediatric Intensive Care Units (PICUs) and Risks Scales Used for This Reason

Year 2019, , 1814 - 1828, 31.12.2019

Abdullah Sarman

https://doi.org/10.30569/adiyamansaglik.609711

Abstract

Delirium is a fulminant disorder with a
fluctuating course and a wide range of underlying causes. It is a commonly
characterized by altered mental status, disturbance of consciousness and
cognition, as well as disruptions in sleep-wake cycle. Falls can be described
often preventable events that happen in hospitalized children. Pediatric
intensive care units are the places where falls occur frequently. Such changes
in consciousness in patients with delirium pose a risk for falls. Various
pediatric fall risk assessment scales have been developed for falling risk that
may develop with changes in consciousness. It is important that nurses who are
in close contact with patients in intensive care and clinical settings
predefined delirium and consciousness changes in patients. In this review
article, it is aimed to give information about the characteristics and purposes
of the measurement instruments commonly used in various age groups in the
literature.

Keywords

Child Patient, Delirium, Falling Risk, Diagnostic Scale, Pediatric Intensive Care Units, Fall Risk Assessment Tool

Pediatrik Yoğun Bakım Ünitelerindeki (PYBÜ) Deliryum Hastalarında Düşme Riski ve Bu Amaçla Kullanılan Ölçekler

Abstract

Deliryum, hızlı başlayan, dalgalı seyir gösteren,
çok farklı nedenlerden dolayı ortaya çıkan, bilinç, algılama, düşünce,
uyku-uyanıklık döngüsü değişimlerinin eşlik ettiği bir klinik sendromdur.
Düşmeler genellikle hastanede yatan çocuklarda meydana gelen önlenebilir
olaylar olarak tanımlanabilir. Pediatrik yoğun bakımlar düşme olaylarının
sıklıkla yaşanabildiği ortamlardır. Deliryumdaki hastalarda oluşan bu tür
bilinç değişikleri düşme açısından risk oluşturur. Bilinç değişimleriyle
beraber gelişebilen düşme riskine yönelik olarak çeşitli pediatrik düşme riski
değerlendirme ölçekleri geliştirilmiştir. Yoğun bakım ve klinik ortamlarda
hastalarla yakın ilişki içerisinde olan hemşirelerin hastalardaki deliryum ve
bilinç değişikliklerini önceden tanımlaması önemlidir. Bu derleme makalede
literatürde çeşitli yaş gruplarında yaygın olarak kullanılan ölçme araçlarının
özellikleri ve kullanım amaçları konusunda bilgi verilmesi amaçlanmaktadır.

Keywords

Pediatrik Hasta, Deliryum, Düşme Riski, Tanı Ölçeği, Pediatrik Yoğun Bakım Ünitesi, Düşme Riski Değerlendirme Aracı

References

• 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th Ed., Washington, DC; 2010.
• 2. Inouye SK. Delirium in older persons. N Engl J Med 2006;354(11):1157–65. doi:10.1056/NEJMra052321.
• 3. Khan BA, Zawahiri M, Campbell NL, Fox GC, Weinstein EJ, Nazir A, et al. Delirium in hospitalized patients: Implications of current evidence on clinical practice and future avenues for research—A systematic evidence review. J Hosp Med 2012;7(7):580–9. doi:10.1002/jhm.1949.
• 4. National Clinical Guideline Centre. Delirium: Diagnosis, Prevention and Management. National Institute for Health and Clinical Excellence: Guidance. London: Royal College of Physicians (UK); 2010. Erişim: https://www.ncbi.nlm.nih.gov/pubmed/22319805. Erişim Tarihi: 20.06.2019.
• 5. Hall RJ, Meagher DJ, MacLullich AMJ. Delirium detection and monitoring outside the ICU. Best Pract Res Clin Anaesthesiol 2012;26(3):367–83. doi:10.1016/j.bpa.2012.07.002.
• 6. Kelly P, Frosch E. Recognition of delirium on pediatric hospital services. Psychosomatics 2012;53(5):446–51. doi:10.1016/j.psym.2012.04.012.
• 7. Godfrey A, Conway R, Leonard M, Meagher D, Ólaighin GM. Motion analysis in delirium: A discrete approach in determining physical activity for the purpose of delirium motoric subtyping. Med Eng Phys 2010;32(2):101–10. doi:10.1016/j.medengphy.2009.10.012.
• 8. Antoon AY, Volpe JJ, Crawford JD. Burn encephalopathy in children. Pediatrics 1972;50(4):609–16.
• 9. Turkel SB, Tavare CJ. Delirium in children and adolescents. J Neuropsychiatry Clin Neurosci 2003;15(4):431–5. doi:10.1176/jnp.15.4.431.
• 10. Schieveld JNM, Leroy PLJM, Van Os J, Nicolai J, Vos GD, Leentjens AFG. Pediatric delirium in critical illness: Phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit. Intensive Care Med 2007;33(6):1033–40. doi:10.1007/s00134-007-0637-8.
• 11. Silver G, Traube C, Kearney J, Kelly D, Yoon MJ, Nash Moyal W, et al. Detecting pediatric delirium: Development of a rapid observational assessment tool. Intensive Care Med 2012;38(6):1025–31. doi:10.1007/s00134-012-2518-z.
• 12. Colville G, Kerry S, Pierce C. Children’s factual and delusional memories of intensive care. Am J Respir Crit Care Med 2008;177(9):976–82. doi:10.1164/rccm.200706-857OC.7.
• 13. Smith HAB, Boyd J, Fuchs DC, Melvin K, Berry P, Shintani A, et al. Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit. Crit Care Med 2011;39(1):150–7. doi:10.1097/CCM.0b013e3181feb489.
• 14. Kain ZN, Caldwell-Andrews AA, Maranets I, McClain B, Gaal D, Mayes LC, et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg 2004;99(6):1648–54. doi:10.1213/01.ANE.0000136471.36680.97.
• 15. Prugh DG, Wagonfeld S, Metcalf D, Jordan K. A clinical study of delirium in children and adolescents. Psychosomatic Medicine 1980;42(1 Suppl.):177–95.
• 16. Hatherill S, Flisher AJ, Nassen R. Delirium among children and adolescents in an urban sub-Saharan African setting. J Psychosom Res 2010;69(2):187–92. doi:10.1016/j.jpsychores.2010.01.011.
• 17. Staggs VS, Mion LC, Shorr RI. Assisted and unassisted falls: Different events, different outcomes, different implications for quality of hospital care. Jt Comm J Qual Patient Saf 2014;40(8):358–64. doi:10.1016/S1553-7250(14)40047-3.
• 18. Fujita Y, Fujita M, Fujiwara C. Pediatric falls: Effect of prevention measures and characteristics of pediatric wards. Jpn J Nurs Sci 2013;10(2):223–31. doi:10.1111/jjns.12004.
• 19. Almis H, Bucak IH, Konca C, Turgut M. Risk factors related to caregivers in hospitalized children’s falls. J Pediatr Nurs 2017;32:3–7. doi:10.1016/j.pedn.2016.10.006.
• 20. Oliver D, Daly F, Martin FC, McMurdo MET. Risk factors and risk assessment tools for falls in hospital in-patients: A systematic review. Age Ageing 2004;33(2):122–30. doi:10.1093/ageing/afh017.
• 21. Kingston F, Bryant T, Speer K. Pediatric falls benchmarking collaborative. J Nurs Adm 2010;40(6):287–92. doi:10.1097/NNA.0b013e3181df10d9.
• 22. Neiman J, Rannie M, Thrasher J, Terry K, Kahn MG. Development, implementation, and evaluation of a comprehensive fall risk program. J Spec Pediatr Nurs 2011;16(2):130–9. doi:10.1111/j.1744-6155.2011.00277.x.
• 23. Jamerson PA, Graf E, Messmer PR, Fields HW, Barton S, Berger A, et al. Inpatient falls in freestanding children’s hospitals. Pediatric Nursing 2014;40(3):127–35.
• 24. McNeely HL, Thomason KK, Tong S. Pediatric Fall Risk Assessment Tool Comparison and Validation Study. J Pediatr Nurs 2018;41:96–103. doi:10.1016/j.pedn.2018.02.010.
• 25. Morse JM. Enhancing the safety of hospitalization by reducing patient falls. Am J Infect Control 2002;30(6):376–80. doi:10.1067/mic.2002.125808.
• 26. Demir D, Yöntem SÇ, Sarı HY, Bektaş M. Development of Diagnostic Falling Risk Scale for Child Patients. SANERC 2013;10(3):34–41.
• 27. Graf E. Magnet Children’s Hospitals: Leading Knowledge Development and Quality Standards for Inpatient Pediatric Fall Prevention Programs. J Pediatr Nurs: Nursing Care of Children and Families 2011;26(2):122–7. doi:10.1016/j.pedn.2010.12.007.
• 28. Hill-Rodriguez D, Messmer PR, Williams PD, Zeller RA, Williams AR, Wood M, et al. The Humpty Dumpty Falls Scale: A Case–Control Study. J Spec Pediatr Nurs 2009;14(1):22–32. doi:10.1111/j.1744-6155.2008.00166.x.
• 29. Rouse MD, Close J, Prante C, Boyd S. Implementation of the Humpty Dumpty Falls Scale: A Quality-Improvement Project. J Emerg Nurs 2014;40(2):181–6. doi:10.1016/j.jen.2012.11.001.
• 30. Ryan-Wenger NA, Kimchi-Woods J, Erbaugh MA, LaFollette L, Lathrop J. Challenges and conundrums in the validation of pediatric fall risk assessment tools. Pediatric Nursing 2012;38(3):159–67.
• 31. DiGerolamo K, Davis KF. An integrative review of Pediatric Fall Risk Assessment Tools. J Pediatr Nurs 2017;34:23–8. doi:10.1016/j.pedn.2017.02.036.
• 32. Özden D, Karagözoğlu Ş, Kurukız S. Determination of Fall Risk According to Hendrich II and Morse Fall Scale: A pilot study. Journal of Anatolia Nursing and Health Sciences 2012;15(1):80–8.
• 33. Tanıl V, Çetinkaya Y, Sayer V, Avşar D, İskit Y. Evaluating fall risk. Sağlık Akademisyenleri Dergisi 2014;1(1):21–6.
• 34. Yöntem S, Gök D, Sarı HY, Güntürkün FA. BUÇH II Fall risk scale in children patients: Comparison with Harizmi and BUÇH Scale. İzmir Dr Behçet Uz Çocuk Hast Dergisi 2017;7(2):105–17. doi:10.5222/buchd.2017.105.