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Performance of Cornell Assessment of Pediatric Delirium Scale in Mechanically Ventilated Children
Neha Gupta1, Saurabh Talathi2, Allison Woolley3
1Division of Pediatric Critical Care, Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States.
Insights
The Cornell Assessment of Pediatric Delirium (CAPD) scale shows variable accuracy in mechanically ventilated children. Adjusting cut-off scores or developing new scales is needed for children with developmental delays to improve delirium diagnosis.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Psychiatry
Background:
- Delirium diagnosis in mechanically ventilated children is challenging due to developmental variations.
- The Cornell Assessment of Pediatric Delirium (CAPD) scale is used for screening.
- Existing diagnostic tools may have limitations in this specific population.
Purpose of the Study:
- To evaluate the performance of the Cornell Assessment of Pediatric Delirium (CAPD) scale in mechanically ventilated children.
- To determine the accuracy of the CAPD scale across different developmental abilities.
- To identify optimal cut-off scores and potential modifications for improved diagnostic accuracy.
Main Methods:
- A prospective, observational study involving 837 paired assessments of CAPD and DSM-V criteria.
- Analysis included sensitivity, specificity, and receiver operating characteristic (ROC) curve analysis.
- Evaluated performance in typically developed versus developmentally delayed children.
Main Results:
- Delirium prevalence was 19% in the study population.
- An overall CAPD score cutoff of 9 yielded 81.8% sensitivity and 44.8% specificity.
- For typically developed children, a CAPD cutoff of 9 was optimal (76.7% sensitivity, 65.4% specificity); for developmentally delayed children, a cutoff of 17 was better (74.4% sensitivity, 63.2% specificity).
- Modifying the scale for developmentally delayed children suggested cutoffs of 5 (typically developed) and 6 (developmentally delayed).
- The standard CAPD cutoff of 9 resulted in a high false-positive rate in mechanically ventilated children with developmental delay.
Conclusions:
- The standard CAPD scale cutoff requires adjustment for mechanically ventilated children, particularly those with developmental delays.
- A CAPD cutoff of 9 demonstrates limited specificity in developmentally delayed pediatric patients.
- Further research is needed to refine delirium assessment tools or develop specific scales for this vulnerable population.
Abstract:
Accuracy of delirium diagnosis in mechanically ventilated children is often limited by their varying developmental abilities. The purpose of this study was to examine the performance of the Cornell Assessment of Pediatric Delirium (CAPD) scale in these patients. This is a single-center, prospective, observational study of patients requiring sedation and mechanical ventilation for 2 days or more. CAPD scale was implemented in our unit for delirium screening. Each CAPD assessment was accompanied by a physician assessment using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Sensitivity analysis was performed to determine the best cut-off score in our target population. We also evaluated ways to improve the accuracy of this scale in patients with and without developmental delay. A total of 837 paired assessments were performed. Prevalence of delirium was 19%. Overall, CAPD score ≥ 9 had sensitivity of 81.8% and specificity of 44.8%. Among typically developed patients, the sensitivity and specificity were 76.7 and 65.4%, respectively, whereas specificity was only 16.5% for developmentally delayed patients. The best cut-off value for CAPD was 9 for typically developed children and 17 for those with developmental delay (sensitivity 74.4%, specificity 63.2%). Some CAPD questions do not apply to patients with sensory and neurocognitive deficits; upon excluding those questions, the best cut-off values were 5 for typically developed and 6 for developmentally delayed children. In mechanically ventilated patients with developmental delay, CAPD ≥ 9 led to a high false-positive rate. This emphasizes the need for either a different cut-off score or development of a delirium scale specific to this patient population.
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