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

Smith, Heidi A. B. MD, MSci; Boyd, Jenny MD; Fuchs, D. Catherine MD; Melvin, Kelly MD; Berry, Pamela RN; Shintani, Ayumi PhD; Eden, Svetlana K. MS; Terrell, Michelle K. NP; Boswell, Tonya RN; Wolfram, Karen RN; Sopfe, Jenna MS; Barr, Frederick E. MD, MSci; Pandharipande, Pratik P. MD, MSci; Ely, E. Wesley MD, MPH

doi: 10.1097/CCM.0b013e3181feb489
Pediatric Critical Care

Objective: To validate a diagnostic instrument for pediatric delirium in critically ill children, both ventilated and nonventilated, that uses standardized, developmentally appropriate measurements.

Design and Setting: A 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.

Patients: A total of 68 pediatric critically ill patients, at least 5 years of age, were enrolled from July 1, 2008, to March 30, 2009.

Interventions: None.

Measurements: Criterion 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.

Results: A 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).

Conclusions: The 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.

From the Department of Anesthesiology (HABS, PB, PPP), Vanderbilt University Medical Center, Nashville, TN; the Department of Pediatrics (HABS, PB, MKT, TB, KW, FEB), Division of Pediatric Critical Care, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN; Department of Anesthesiology (JB), Division of Pediatric Critical Care, University of North Carolina, Chapel Hill, NC; the Department of Psychiatry (DCF, KM), Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, Nashville, TN; the Department of Biostatistics (AS, SKE), Vanderbilt University, Nashville, TN; Vanderbilt University Medical School (JS), Emphasis Program, Nashville, TN; the Anesthesiology Service (PPP), Veterans Affairs (VA) TN Valley Health Care System, Nashville, TN; and the Department of Internal Medicine (EWE), Center for Health Services Research and Division of Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, and the Tennessee Valley VA Geriatric Research, Education and Clinical Center.

Dr. Pandharipandge is supported by a Veterans Affairs Career Development Award, the Clinical Science Research and Development (CSRD) program; and received honoraria/speaking fees and grants from Hospira. Dr. Ely is supported by the National Institutes of Health (AG027472) and the Veterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center (GRECC), Nashville,TN; consulted for Eli Lilly and consulted for and received grants from Hospira and Pfizer. The remaining authors have not disclosed any potential conflicts of interest.

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© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins