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Detecting pediatric delirium: development of a rapid observational assessment tool
Gabrielle Silver1, Chani Traube, Julia Kearney
1Child Psychiatry, Weill Cornell Medical College, NY Presbyterian Hospital, New York, NY 10065, USA.
Insights
The Cornell Assessment of Pediatric Delirium (CAP-D) shows excellent 97% concordance with DSM-IV criteria for detecting delirium in pediatric intensive care unit (PICU) patients. This tool may be a valid screening method for all pediatric patients in the PICU.
Area of Science:
- Pediatric critical care medicine
- Child and adolescent psychiatry
- Medical device development
Background:
- Delirium is a serious condition in pediatric intensive care units (PICUs).
- Accurate and timely detection of delirium is crucial for patient outcomes.
- Existing screening tools may have limitations in the diverse PICU population.
Purpose of the Study:
- To develop and evaluate a novel screening tool, the Cornell Assessment of Pediatric Delirium (CAP-D).
- To assess the feasibility and validity of the CAP-D for detecting delirium in PICU patients of all ages.
- To compare CAP-D performance against psychiatric assessment using DSM-IV criteria.
Main Methods:
- A prospective, blinded pilot study was conducted in a university hospital PICU.
- Fifty patients aged 3 months to 21 years were included over a 6-week period.
- Two independent teams assessed patients using the CAP-D and psychiatric evaluation based on DSM-IV criteria.
Main Results:
- The Cornell Assessment of Pediatric Delirium (CAP-D) demonstrated excellent concordance (97%) with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria.
- The prevalence of delirium in the studied pediatric intensive care unit sample was 29%.
- The study confirmed the feasibility of performing the CAP-D in a PICU setting.
Conclusions:
- The CAP-D shows potential as a valid screening tool for identifying delirium in pediatric intensive care unit patients across all age groups.
- Further research is warranted to confirm its validity, inter-rater reliability, and practical application as a nursing screen.
- The CAP-D may improve early detection and management of delirium in critically ill children.
Objective:
Development of a novel screening tool for the detection of delirium in pediatric intensive care unit (PICU) patients of all ages by comparison with psychiatric assessment based on the reference standard Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria.
Methods:
This was a prospective blinded pilot study investigating the feasibility of the Cornell Assessment of Pediatric Delirium (CAP-D) performed in a PICU at a university hospital. Fifty patients, ages 3 months to 21 years, admitted to the PICU over a 6-week period were included. No interventions were performed.
Results:
After informed consent was obtained, two study teams independently assessed for delirium by completing the CAP-D and by conducting psychiatric evaluation based on the DSM-IV criteria. Concordance between the CAP-D and DSM-IV criteria was excellent, at 97%. Prevalence of delirium in this sample was 29%.
Conclusion:
The CAP-D may be a valid screen for identification of delirium in PICU patients of all ages. Further studies are required to explore its validity, inter-rater reliability, and feasibility of use as a nursing screen.
