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Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric

Jan N M Schieveld1, Judith A van der Valk, Inge Smeets

  • 1Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, European Graduate School of Neuroscience, SEARCH, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands. jan.schieveld@mumc.nl

Intensive Care Medicine
|September 23, 2009
PubMed

Insights

Pediatric delirium (PD) is often under-diagnosed in intensive care units. This study proposes a new diagnostic algorithm to aid recognition and management of PD in pediatric patients.

Area of Science:

  • Pediatric critical care medicine
  • Neuroscience
  • Psychiatry

Background:

  • Delirium is frequently under-diagnosed in pediatric intensive care units (PICU).
  • Lack of diagnosis hinders efforts to reverse delirium.
  • Validated tools are needed for delirium recognition in children.

Purpose of the Study:

  • To relate pediatric delirium (PD) presentations to standard criteria.
  • To develop a diagnostic algorithm for PD.
  • To improve the recognition and management of PD in PICU.

Main Methods:

  • Evaluation of sedation-agitation levels in PICU patients.
  • Psychometric assessment of patient behavior.
  • Incorporation of caregiver opinions into the diagnostic process.

Main Results:

  • Delirium-inducing factors, consciousness disturbances, and inattention are common in PICU patients.
  • A pre-delirious state is present in most PICU patients.
  • A novel diagnostic algorithm integrating sedation, behavior, and caregiver input was developed.

Conclusions:

  • This is the first proposed diagnostic algorithm for pediatric delirium.
  • Daily evaluation is mandatory due to the high prevalence of pre-delirious states.
  • Further refinement of the algorithm, potentially including neurocognitive measures, is needed.
Abstract

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