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Delirium Detection Based on the Clinical Experience of Pediatric Intensivists
Roberta Esteves Vieira de Castro1,2, Maria Clara de Magalhães-Barbosa2, Antônio José Ledo Alves da Cunha2,3
1Departamento de Pediatria, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
Objectives:
To estimate the frequency of delirium detected by pediatric intensivists, based only on their clinical experience, without a valid and reliable tool.
Design:
Multicenter, prospective, descriptive, observational study.
Settings:
Three PICUs in Rio de Janeiro, Brazil.
Patients:
Twenty-nine days to 18 years old.
Interventions:
Electronic forms were sent weekly to the pediatric intensivists responsible for the daily care of patients from March to September 2015, to fill in information about the presence of risk factors and diagnosis of delirium in all patients who remained in the PICU in the last week. Demographics and other clinical data were extracted from an electronic system.
Measurements And Main Results:
A total of 504 admissions in the three PICUs (477 patients) were included. The pediatric intensivists reported only two episodes of delirium in two different patients, based on insufficient criteria. Considering all PICUs admissions, the reported frequency of delirium was only 0.4% (2/504).
Conclusions:
The low frequency of delirium detection and the insufficient criteria used for the diagnosis in these units suggest flaws in the recognition of delirium and probably the occurrence of underdiagnosis/misdiagnosis when it is based only on clinical experience, without the use of a valid and reliable tool.
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