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Delirium screening anchored in child development: The Cornell Assessment for Pediatric Delirium
Gabrielle Silver1, Julia Kearney2, Chani Traube1
1Weill Cornell Medical College/New York Presbyterian Hospital,New York,New York.
Insights
The Cornell Assessment for Pediatric Delirium (CAPD) uses developmental anchor points to help nurses reliably screen hospitalized children for delirium. This validated tool improves accuracy by considering age-specific behaviors in sick children.
Area of Science:
- Pediatric critical care medicine
- Child psychology and development
- Nursing assessment and diagnostics
Background:
- Delirium is a common yet underrecognized condition in hospitalized children.
- Existing screening tools may lack age-specific developmental considerations.
- The Cornell Assessment for Pediatric Delirium (CAPD) was recently validated as a bedside nursing screen.
Purpose of the Study:
- To introduce a "developmental anchor points" reference chart for the CAPD.
- To provide clinicians with age-specific guidance for assessing delirium symptoms in children.
- To enhance the interpretative reliability and diagnostic accuracy of the CAPD.
Main Methods:
- Development of the CAPD screening tool incorporating developmental considerations.
- Formulation and expert multidisciplinary panel review of a "developmental anchor points" chart.
- Evaluation of content validity, including sick behaviors in a hospital setting.
Main Results:
- The CAPD developmental anchor points chart covers key pediatric age groups (newborn to 2 years).
- The chart served as a basis for nurse training and bedside reference during validation.
- Implementation highlighted the importance of nurse collaboration and challenges in establishing developmental baselines.
Conclusions:
- The CAPD, augmented by developmental anchor points, offers a validated, structured, and developmentally informed approach to pediatric delirium screening.
- Minimal training enables bedside nurses and pediatric practitioners to reliably identify children at risk for delirium.
- This approach supports accurate delirium diagnosis in diverse pediatric populations.
Objective:
The recently validated Cornell Assessment for Pediatric Delirium (CAPD) is a new rapid bedside nursing screen for delirium in hospitalized children of all ages. The present manuscript provides a "developmental anchor points" reference chart, which helps ground clinicians' assessment of CAPD symptom domains in a developmental understanding of the presentation of delirium.
Method:
During the development of this CAPD screening tool, it became clear that clinicians need specific guidance and training to help them draw on their expertise in child development and pediatrics to improve the interpretative reliability of the tool and its accuracy in diagnosing delirium. The developmental anchor points chart was formulated and reviewed by a multidisciplinary panel of experts to evaluate content validity and include consideration of sick behaviors within a hospital setting.
Results:
The CAPD developmental anchor points for the key ages of newborn, 4 weeks, 6 weeks, 8 weeks, 28 weeks, 1 year, and 2 years served as the basis for training bedside nurses in scoring the CAPD for the validation trial and as a multifaceted bedside reference chart to be implemented within a clinical setting. In the current paper, we discuss the lessons learned during implementation, with particular emphasis on the importance of collaboration with the bedside nurse, the challenges of establishing a developmental baseline, and further questions about delirium diagnosis in children.
Significance Of Results:
The CAPD with developmental anchor points provides a validated, structured, and developmentally informed approach to screening and assessment of delirium in children. With minimal training on the use of the tool, bedside nurses and other pediatric practitioners can reliably identify children at risk for delirium.
