Delirium Assessment in the Pediatric ICU
DIPI-ICU, A prospective observational cohort study
Published

A critically ill child is a special challenge for doctors around the world. Brain function in the evolving brain is different from that of adult brains and requires special attention. Even though data on delirium in children are still limited, there is preliminary evidence for significantly worse outcome in children with delirium compared to children without delirium.

 

We evaluated test validity and reliability of the Pediatric Confusion Assessment Method for the ICU (pCAM-ICU), the Pediatric Anesthesia Emergence Delirium (PAED) scale, and our newly created pCAM-ICU severity scale (sspCAM-ICU) for the detection of delirium in PICU patients. We used daily repeated assessments in the same patient to mimic the use of scores in clinical routine.

Sixty-four patients were enrolled and 214 assessments were conducted and included in data analysis. The first assessments within each patient revealed sensitivities of 69.2% for the Pediatric Anesthesia Emergence Delirium scale, 76.9% for the Pediatric Confusion Assessment Method for the ICU, and 84.9% for the severity scale for the Pediatric Confusion Assessment Method for the ICU. Specificities were 98% for all scores. Considering repeated measurements, sensitivities decreased to 35.9% for the Pediatric Anesthesia Emergence Delirium scale and to 52.3% for the Pediatric Confusion Assessment Method for the ICU. The sensitivity of the severity scale for the Pediatric Confusion Assessment Method for the ICU dropped to 71.8%, which was significantly higher compared to the Pediatric Anesthesia Emergence Delirium scale (p = 0.0008). Receiver operator characteristic regression unveiled that sedation and mechanical ventilation had a significant negative effect on the validity of the Pediatric Anesthesia Emergence Delirium scale and the severity scale for the Pediatric Confusion Assessment Method for the ICU. Age and gender had a significant impact on the receiver operator characteristic curve of the severity scale for the Pediatric Confusion Assessment Method for the ICU.

In summary, the new Severity Scale for the pCAM-ICU showed the best test validity when used in critically ill children of 5 years old or older. Nevertheless, validity of delirium screening itself depends on patient specific factors. These factors should be taken into consideration when choosing a delirium screening instrument.

Read the full paper published in Critical Care Medicine