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Risk Factors and Nomogram Model of Postoperative Delirium in Children with Congenital Heart Disease: A Single-Center Prospective Study

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Abstract

Delirium is a common postoperative complication in children with congenital heart disease, which affects their postoperative recovery. The purpose of this study is to explore the risk factors of delirium and construct a nomogram model to provide novel references for the prevention and management of postoperative delirium in children with congenital heart disease. 470 children after congenital heart surgery treated in the cardiac intensive care unit (CICU) of Shanghai Children’s Medical Center were divided into a model and a validation cohort according to the principle of 7:3 distribution temporally. Then, the delirium-related influencing factors of 330 children in the training cohort were analyzed, and the nomogram model was established by a combination of Lasso regression and logistic regression. The data of 140 children in the validation cohort were used to verify the effectiveness of the model. Multivariable logistic regression analysis showed that age, disease severity, non-invasive ventilation after extubation, delayed chest closure, phenobarbital dosage, promethazine dosage, mannitol usage, and elevated temperature were independent risk factors for postoperative delirium. The area under the receiver operating characteristic curve (AUC) of the nomogram model was 0.864 and the Brier value was 0.121. Regarding the validation of the model’s effect, our results showed that 51 cases were predicted by the model and 34 cases actually occurred, including 4 cases of false negative and 21 cases of false positive. The positive predictive value of the model was 58.8%, and its negative predictive value was 95.5%. The nomogram model established in this study showed acceptable performance in predicting postoperative delirium in children with congenital heart disease.

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Data Availability

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

CICU:

Cardiac intensive care unit

AUC:

Area under the receiver operating characteristic curve

RASS:

Richmond agitation-sedation scale

CAPD:

Cornell assessment of pediatric delirium

EMR:

Electronic medical records

ROC:

Receiver operating characteristic

PICU:

Pediatric intensive care unit

ICU:

Intensive care unit

CI:

Confidence interval

RACHS-1:

Risk heart adjustment for congenital surgery-1

STS-EACTS:

The Society of Thoracic Surgeons and the European Association for Cardiothoracic Surgery Congenital Heart Surgery Mortality Score

PRISM III:

Pediatric risk of mortality III

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Acknowledgements

Our team would like to thank the staff and all the nurses who assisted in the investigation. We also would like to show our appreciation to the CICU team for supporting our research team. This research was funded by the Research Project on Science and Technology Innovation Think Tank of Fujian Science and Technology Association (FJKX-A2131) and Nursing discipline construction project of Shanghai Jiao Tong University School of Medicine (SJTUHLXK2021).

Funding

Research Project on Science and Technology Innovation Think Tank of Fujian Science and Technology Association, FJKX-A2131, FJKX-A2131, Nursing discipline construction project of Shanghai Jiao Tong University School of Medicine, SJTUHLXK2021.

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Authors and Affiliations

  1. School of Nursing, Shanghai Jiao Tong University, No. 227 Chongqing South Road, Shanghai, China

    Dou Mao

  2. College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), No. 966, Hengyu Road, Jin’an District, Fuzhou, China

    Lijuan Fu

  3. Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, China

    Wenlan Zhang

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Contributions

(I) Conception and design: DM, LF; (II) Administrative support: LF; (III) Provision of study materials or patients: LF; (IV) Collection and assembly of data: DM and WZ; (V) Data analysis and interpretation: DM and WZ; (VI) Manuscript writing: all authors; (VII) Final approval of manuscript: all authors.

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Correspondence to Lijuan Fu.

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Mao, D., Fu, L. & Zhang, W. Risk Factors and Nomogram Model of Postoperative Delirium in Children with Congenital Heart Disease: A Single-Center Prospective Study. Pediatr Cardiol 45, 68–80 (2024). https://doi.org/10.1007/s00246-023-03297-5

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