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Determining Interrater Reliability of the Cornell Assessment of Pediatric Delirium Screening Tool Among PICU Nurses

Valdivia, Hector R., MN, RN, CCRN1; Carlin, Kristen E., MPH2

Pediatric Critical Care Medicine: April 2019 - Volume 20 - Issue 4 - p e216–e220
doi: 10.1097/PCC.0000000000001896
Online Clinical Investigations

Objectives: To determine the interrater reliability of the Cornell Assessment of Pediatric Delirium Screening Tool amount PICU nurses.

Design: The design was setup as a cross-sectional study and conducted over the course of a year.

Setting: This study setting was a PICU and a pediatric cardiac ICU at Seattle Children’s Hospital, a tertiary freestanding university-affiliated hospital in Seattle, Washington.

Patients: A total sample of 108 patients were included in this study. Patients were selected using a convenience sample. Inclusion in this study involved all patients eligible for a Cornell Assessment of Pediatric Delirium assessment, reflecting practice standards. Exclusion criteria included patients who had a Richmond Agitation and Sedation Score of (–4) or (–5), based on the Cornell Assessment of Pediatric Delirium procedure. There were 113 patients screened, but five were excluded from the final sample size due to missing information.

Interventions: The research nurse would screen the patient using the Cornell Assessment of Pediatric Delirium during the 12:00 noon hour, which coincided with the clinical nurse Cornell Assessment of Pediatric Delirium assessment. The clinical and research nurse were kept blind to each other’s assessment. Scores were then analyzed to determine the kappa coefficient.

Measurements and Main Results: The kappa coefficient between nurses was found to be 0.60 (95% CI, 0.44–0.76), indicating moderate agreement. Age was found to have a higher association with agreement. In children 2 years old or greater, the kappa coefficient was 0.85 (95% CI, 0.68–1.00). Children whose raters did not agree on scoring were more likely to be younger than those who had raters that agreed (p < 0.01).

Conclusions: Evaluating the interrater reliability of clinical tool, such as the Cornell Assessment of Pediatric Delirium, may be important to more accurately identify patients at high risk of delirium in a PICU or pediatric cardiac ICU. The evaluation of the tool’s performance in practice may also be helpful to ensure ongoing consistency among the clinical nurses that complete these assessments on a daily basis.

1Pediatric Intensive Care Unit and Clinical Effectiveness, Seattle Children’s Hospital, Seattle, WA.

2Children’s Core for Biomedical Statistics, Center for Clinical and Translational Research Seattle Children’s Research Institute, Seattle, WA.

Mr. Valdivia received funding from Seattle Children’s Hospital (Nursing Research Grant). Ms. Carlin disclosed that she does not have any potential conflicts of interest.

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©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies