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CC BY-NC-ND 4.0 · J Pediatr Intensive Care 2024; 13(01): 046-054
DOI: 10.1055/s-0041-1736523
Original Article

Antipsychotic Drug Prescription in Pediatric Intensive Care Units: A 10-Year U.S. Retrospective Database Study

Kate Madden 
1   Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States
,
Michael Wolf
2   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
,
Robert C. Tasker
1   Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States
,
Janet Figueroa
2   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
,
Courtney McCracken
2   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
,
Matt Hall
3   Children's Hospital Association, Lenexa, Kansas, United States
,
Pradip Kamat
2   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
4   Division of Critical Care, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, United States
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Abstract

Delirium recognition during pediatric critical illness may result in the prescription of antipsychotic medication. These medications have unclear efficacy and safety. We sought to describe antipsychotic medication use in pediatric intensive care units (PICUs) contributing to a U.S. national database. This study is an analysis of the Pediatric Health Information System Database between 2008 and 2018, including children admitted to a PICU aged 0 to 18 years, without prior psychiatric diagnoses. Antipsychotics were given in 16,465 (2.3%) of 706,635 PICU admissions at 30 hospitals. Risperidone (39.6%), quetiapine (22.1%), and haloperidol (20.8%) were the most commonly used medications. Median duration of prescription was 4 days (interquartile range: 2–11 days) for atypical antipsychotics, and haloperidol was used a median of 1 day (1–3 days). Trend analysis showed quetiapine use increased over the study period, whereas use of haloperidol and chlorpromazine (typical antipsychotics) decreased (p < 0.001). Compared with no antipsychotic administration, use of antipsychotics was associated with comorbidities (81 vs. 65%), mechanical ventilation (57 vs. 36%), longer PICU stay (6 vs. 3 days), and higher mortality (5.7 vs. 2.8%) in univariate analyses. In the multivariable model including demographic and clinical factors, antipsychotic prescription was associated with mortality (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.02–1.18). Use of atypical antipsychotics increased over the 10-year period, possibly reflecting increased comfort with their use in pediatric patients. Antipsychotics were more common in patients with comorbidities, mechanical ventilation, and longer PICU stay, and associated with higher mortality in an adjusted model which warrants further study.

Keywords

antipsychotic - delirium - pediatric critical care

Authors' Contributions

K.M., R.C.T., J.F., C.M., and P.K. participated in the concept and design, analysis and interpretation of data, and drafting or revising of the manuscript. M.W. and M.H. participated in interpretation of data and revising of the manuscript. All authors have approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


Supplementary Material



Publication History

Received: 10 July 2021

Accepted: 31 August 2021

Article published online:
22 October 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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