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Pediatric delirium: evaluating the gold standard
Gabrielle Silver1, Julia Kearney2, Chani Traube1
1Weill Cornell Medical College,New York,New York.
Insights
Child psychiatrists demonstrated high reliability diagnosing pediatric delirium using psychiatric exams. This diagnostic method is effective even in critically ill, young, and developmentally delayed children.
Area of Science:
- Pediatric Psychiatry
- Child Neurology
- Critical Care Medicine
Background:
- Pediatric delirium diagnosis is challenging in critically ill children.
- Standardized diagnostic criteria are essential for reliable assessment.
Purpose of the Study:
- To evaluate the interrater reliability of pediatric delirium diagnosis by child psychiatrists.
- To assess the reliability of psychiatric interviews and exams in diverse pediatric populations.
Main Methods:
- Seventeen critically ill patients (0-21 years) were assessed for delirium using DSM-IV criteria.
- Two blinded child psychiatrists independently diagnosed delirium.
- Interrater reliability was measured using Cohen's kappa coefficient.
Main Results:
- High interrater reliability was observed for the psychiatric assessment (Cohen's κ = 0.94).
- Excellent reliability was consistent across different age groups, developmental statuses, and intubation conditions (κ range 0.81-1.00).
Conclusions:
- Psychiatric interviews and exams are highly reliable for diagnosing delirium in pediatric patients.
- A developmental approach is recommended for diagnosing delirium in challenging pediatric populations.
Objective:
Our aim was to evaluate interrater reliability for the diagnosis of pediatric delirium by child psychiatrists.
Method:
Critically ill patients (N = 17), 0-21 years old, including 7 infants, 5 children with developmental delay, and 7 intubated children, were assessed for delirium using the Diagnostic and Statistical Manual-IV (DSM-IV) (comparable to DSM-V) criteria. Delirium assessments were completed by two psychiatrists, each blinded to the other's diagnosis, and interrater reliability was measured using Cohen's κ coefficient along with its 95% confidence interval.
Results:
Interrater reliability for the psychiatric assessment was high (Cohen's κ = 0.94, CI [0.83, 1.00]). Delirium diagnosis showed excellent interrater reliability regardless of age, developmental delay, or intubation status (Cohen's κ range 0.81-1.00).
Significance Of Results:
In our study cohort, the psychiatric interview and exam, long considered the "gold standard" in the diagnosis of delirium, was highly reliable, even in extremely young, critically ill, and developmentally delayed children. A developmental approach to diagnosing delirium in this challenging population is recommended.
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