Recognition of delirium on pediatric hospital services

Identify the frequency with which pediatric care teams recognize delirium in patients referred for psychiatric consultation, whether their diagnosis is substantiated by the involved consultant, and whether this diagnosis is documented in the discharge problem list.

A retrospective chart review was conducted on all inpatient children receiving consultation from the Child and Adolescent Psychiatry service between 2003 and 2011. Additionally, the problem lists of all inpatient pediatric discharges during that period were examined for the diagnosis of "delirium" or "encephalopathy".

Six of the 515 children referred to psychiatry for any reason were diagnosed with delirium by the pediatric team. The diagnosis was confirmed by psychiatry in all cases. An additional 47 cases of delirium were diagnosed by psychiatry in this same cohort, a condition never mentioned in the pediatric chart. Only 8 of the total 53 patients (15.1%) diagnosed with delirium by pediatrics and/or psychiatry had this condition listed in the discharge problem list. Overall, diagnoses of delirium or encephalopathy were included in only 89 of the total 64,046 problem lists for any pediatric discharge.

Delirium was not noted or mentioned in 88.7% of delirious patients referred for psychiatric consultation, potentially because it was never diagnosed by pediatrics. There is a low documentation rate of this condition on the discharge problem list, even in those children so diagnosed by pediatrics. These findings highlight the important role of the consultation psychiatrist as an educator as well as a diagnostician.