Use of delirium screening tools in the pediatric ICU: unnecessarily burdensome

Delirium screening is widely recommended in pediatric ICUs, despite persistent uncertainty about what delirium represents biologically, how accurately it can be measured, and whether its detection improves outcomes. Screening tools are increasingly embedded into routine care, even as concerns grow about overdiagnosis, workflow burden, and the absence of effective, evidence-based treatments.

Delirium in critically ill children reflects heterogeneous acute brain dysfunction rather than a single disease entity. Validated screening tools show variable reliability and specificity, particularly in infants, children with neurodevelopmental delay, and those speaking a different language than the evaluator. Real-world implementation is limited by subjectivity and substantial nursing cognitive burden. Although delirium is associated with worse outcomes, evidence that screening or pharmacologic treatment alters these outcomes is weak. Pediatric drug trials are scarce, largely retrospective, and show inconsistent benefits with measurable risks.

Current evidence does not support routine delirium screening as a strategy that improves outcomes in critically ill children. Given limited diagnostic precision and lack of effective therapies, clinical and research efforts should prioritize universal prevention strategies that target modifiable drivers of acute brain dysfunction, rather than widespread screening for a poorly defined and variably measured syndrome.