P0055 / #864: ANTIPSYCHOTIC PRESCRIBING PRACTICES IN CRITICALLY ILL CHILDREN: ARE CARDIAC PATIENTS DIFFERENT?

Aims & Objectives: PICU delirium prevalence ranges from 10%-30%, and in children undergoing cardiac surgery the prevalence can be 50%. The objective of this study was to characterize antipsychotic prescribing in critically ill children, and examine potential differences in prescribing practices for children with cardiac disease. Methods: Data were obtained from the PARK-PICU (Prevalence of Acute Rehab for Kids in the PICU) study, a national 2-day point prevalence study of acute rehabilitation practices in PICUs. Any patient admitted to a PICU for greater than 72 hours was included in data collection. Antipsychotic prescribing practices were compared between children with and without a primary cardiac diagnosis as the admission reason. Results: Among 82 PICUs, data collected for 1,769 patients; 31% (556/1769) primary cardiac diagnosis. Among all patients, 5.6% were prescribed an antipsychotic, 6.2% non-cardiac patients and 4.1% cardiac patients (p=0.07). Within the group prescribed an antipsychotic, cardiac patients were less likely to have a delirium screen (43% vs. 62%). Cardiac patients receiving antipsychotics were more likely to be <3 years of age (70%). Quetiapine was most commonly prescribed for non-cardiac patients (49%), while risperidone was the most common in cardiac patients (50%). No cardiac patients were prescribed haloperidol. Conclusions: While there was no significant difference in the prevalence of antipsychotic use between cardiac and non-cardiac patients, cardiac patients on antipsychotics were younger and less likely to be screened for delirium or prescribed haloperidol. These data provide important information about current practices surrounding delirium in cardiac patients and highlights avenues for research to optimize delirium prevention and management.