Background: Pediatric delirium is a complex neuropsychiatric syndrome that has increasingly been recognized in recent literature as an important entity in prognosis and outcomes. Validated intensive care unit screening tools have aided in recognition and diagnosis, but there is little to no research on tools and risk factors for delirium prior to hospitalization and during the natural time course of pretransplant periods.
Objective: Our study aims to describe associated risk factors for delirium in the pretransplant to transplant period and evaluate the utility of our delirium risk assessment (DRA) tool in predicting delirium occurrence along with these risk factors.
Design/Methods: We retrospectively reviewed charts of all patients receiving a psychological assessment for pre-transplant cardiac or pulmonary evaluation who were admitted to the cardiothoracic intensive care unit (CTICU) between 6/12/2019 and 3/5/2024. We compared items on the DRA with patients validated delirium screening tool scores, demographics, psychosocial factors, and psychiatric diagnoses during pre-transplant evaluation.
Results: 246 pre-transplant patients were admitted to the CTICU over the 4.5-year study period.19% of the patients died, 23% had yet to receive a transplant, and had 3 average admissions per patient. Over half (52%) of patients had not had a DRA despite standard implementation since April 2016, and 31% of patients with DRAs had known prior personal and/or family history of delirium. 63 of the 246 patients had both a DRA and a valid delirium screening score (“double-screened patients”) in the CTICU. 54% of these patients had a positive delirium score. 29% of the double-screened patients who were delirious had prior histories of delirium on the DRA. White race trended towards significance (OR 2.88, CI 0.98-8.91) in association with no prior history of delirium on the DRA. 
Conclusion: Delirium was common across the spectrum of pretransplant patients admitted to the cardiothoracic intensive care unit. We hope this work adds to pediatric delirium awareness, as it is an important risk factor to assess for all pretransplant patients given its occurrence rates, long pretransplant periods, involving multiple admissions, and high rates of association with death. The DRA can provide value in anticipatory guidance and planning that should be further evaluated over longer periods of time and in larger populations, as most patients had pretransplant evaluations predating the DRA despite its implementation over 3 years prior to study initiation and almost 9 years before study end. Potential identification bias and prevalence in different races and ethnicities should particularly be further explored.