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Abstract O-02: EVALUATING THE ACCURACY OF PAEDIATRIC ATTENDING PHYSICIANS IN DETECTING DELIRIUM IS EXPOSURE KEY?

Paterson, R.1; Long, D.2; De Young, A.1; Dow, B.3; Dorofaeff, T.2; McKenna, R.2; Kenardy, J.3

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 4
doi: 10.1097/01.pcc.0000537344.00571.96
Oral Abstracts
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1University of Queensland, Centre for Children’s Health Research, Brisbane, Australia

2Lady Cilento Children’s Hosptial, Paediatric Intensive Care Unit, Brisbane, Australia

3University of Queensland, School of Psychology, Brisbane, Australia

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Aims & Objectives:

Delirium diagnosis in critically ill children is multifactorial and fraught with challenges. Current evidence suggests that medical diagnosis of delirium is unreliable. A sub-study of a larger delirium project, the primary aim of this research was to examine the psychometric properties of medical decision-making for delirium screening.

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Methods

Participants were attending physicians (n = 16) at an Australian tertiary referral mixed-PICU. Eligible children (> 6 months, SBS > -2) were reviewed for delirium once daily, up to five days, by an attending physician. Psychometric properties were compared against the gold-standard using sensitivity, specificity and receiver operator characteristic curves. Further comparisons were made between two doctors who acted as study ‘champions’ and all other attending physicians.

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Results

A total of 80 children were recruited to the study and 101 paired assessments were undertaken. The incidence of delirium in this sample was 13.9% and a total of 39 (38.6%) of assessments were undertaken by one of the study champions. Table 1 summarises the main findings. Overall, medical staff were able to detect delirium with reasonable accuracy (AUC = 78.6, 95% CI = 59.5–97.7), however diagnostic accuracy was significantly better when patients were reviewed by one of the two study champion doctors (AUC = 88.5; 95% CI = 67.3–100.0).

Table

Table

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Conclusions

Historically, medical decision-making alone has been viewed as an unreliable method of detecting delirium. These findings indicate that, while overall, physicians’ assessments of paediatric delirium can be accurate, exposure to delirium and delirium research can improve this accuracy.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies