Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method...

Area of Science:

• Pediatric Critical Care Medicine
• Child Psychiatry
• Neuroscience

Background:

• Pediatric delirium is a common and serious complication in critically ill children.
• Accurate and timely diagnosis is crucial for effective management and improved outcomes.
• Existing diagnostic tools may not be suitable for the unique needs of critically ill pediatric populations.

Purpose of the Study:

• To validate the Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU) as a diagnostic instrument for pediatric delirium.
• To assess the instrument's performance in critically ill children, both ventilated and nonventilated.
• To ensure the use of standardized, developmentally appropriate measurements for accurate delirium assessment.

Main Methods:

• A prospective observational cohort study was conducted in a university-based medical center's pediatric intensive care units.
• The study enrolled 68 critically ill pediatric patients aged 5 years and older.
• Criterion validity and interrater reliability of the pCAM-ICU were assessed against diagnoses made by pediatric psychiatrists using DSM-IV-TR criteria.

Main Results:

• The pCAM-ICU demonstrated high diagnostic accuracy with a sensitivity of 83% and specificity of 99% compared to the reference standard.
• Interrater reliability was excellent, with a kappa value of 0.96.
• A total of 146 paired assessments were completed among the 68 enrolled patients.

Conclusions:

• The pCAM-ICU is a highly valid and reliable instrument for diagnosing pediatric delirium in critically ill children aged 5 years and older.
• Its use can expedite diagnosis and consultation with neuropsychiatry specialists for timely treatment.
• The pCAM-ICU offers a potential means for delirium monitoring in future research involving critically ill children.