• Critical care medicine · Jan 2011

    Comparative Study

    Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit.

    • Heidi A B Smith, Jenny Boyd, D Catherine Fuchs, Kelly Melvin, Pamela Berry, Ayumi Shintani, Svetlana K Eden, Michelle K Terrell, Tonya Boswell, Karen Wolfram, Jenna Sopfe, Frederick E Barr, Pratik P Pandharipande, and E Wesley Ely.
    • Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA. heidi.smith@vanderbilt.edu
    • Crit. Care Med. 2011 Jan 1; 39 (1): 150-7.

    ObjectiveTo validate a diagnostic instrument for pediatric delirium in critically ill children, both ventilated and nonventilated, that uses standardized, developmentally appropriate measurements.Design And SettingA prospective observational cohort study investigating the Pediatric Confusion Assessment Method for Intensive Care Unit (pCAM-ICU) patients in the pediatric medical, surgical, and cardiac intensive care unit of a university-based medical center.PatientsA total of 68 pediatric critically ill patients, at least 5 years of age, were enrolled from July 1, 2008, to March 30, 2009.InterventionsNone.MeasurementsCriterion validity including sensitivity and specificity and interrater reliability were determined using daily delirium assessments with the pCAM-ICU by two critical care clinicians compared with delirium diagnosis by pediatric psychiatrists using Diagnostic and Statistical Manual, 4th Edition, Text Revision criteria.ResultsA total of 146 paired assessments were completed among 68 enrolled patients with a mean age of 12.2 yrs. Compared with the reference standard for diagnosing delirium, the pCAM-ICU demonstrated a sensitivity of 83% (95% confidence interval, 66-93%), a specificity of 99% (95% confidence interval, 95-100%), and a high interrater reliability (κ = 0.96; 95% confidence interval, 0.74-1.0).ConclusionsThe pCAM-ICU is a highly valid reliable instrument for the diagnosis of pediatric delirium in critically ill children chronologically and developmentally at least 5 yrs of age. Use of the pCAM-ICU may expedite diagnosis and consultation with neuropsychiatry specialists for treatment of pediatric delirium. In addition, the pCAM-ICU may provide a means for delirium monitoring in future epidemiologic and interventional studies in critically ill children.

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