Clinicians treating youth with ASD may be able to use this information to balance the risks and benefits of SGA treatment when managing ASD-associated irritability.

Background The COVID-19 pandemic led to rapid changes in clinical service delivery across hospital systems nationally. Local realities and resources were key driving factors impacting workflow changes, including for pediatric consultation-liaison psychiatry service (PCLPS) providers. Objective This study aims to describe the early changes implemented by 22 PCLPSs from the US and Canada during the COVID-19 pandemic. Understanding similarities and differences in adaptations made to PCLPS care delivery can inform best practices and future models of care. Methods A 20-point survey relating to PCLPS changes during the COVID-19 pandemic was sent to professional listservs. Baseline hospital demographics, hospital and PCLPS workflow changes, and PCLPS experience were collected from March 20, 2020 – April 28, 2020 and August 18, 2020 – September 10, 2020. Qualitative data were collected from responding sites. An exploratory thematic analysis approach was used to analyze the qualitative data that was not dependent on pre-determined coding themes. Descriptive statistics were calculated using Microsoft Excel. Results 22 academic hospitals in the US and Canada responded to the survey, with an average of 303 beds/hospital. Most respondents (18/22) were children’s hospitals. Despite differences in regional impact of COVID-19 and resource availability, there was significant overlap in respondent experiences. Restricted visitation to one caregiver, use of virtual rounding, ongoing trainee involvement, and an overall low number of COVID-positive pediatric patients were common. While there was variability in PCLPS care delivery occurring virtually versus in person, all respondents maintained some level of on-site presence. Technological limitations and pediatric provider preference led to increased on-site presence. Conclusions To our knowledge, this is the first multi-center study exploring pandemic-related PCLPS changes in North America. Findings of this study demonstrate that PCLPSs rapidly adapted to COVID-19 realities. Common themes emerged that may serve as a model for future practice. However, important gaps in understanding their effectiveness and acceptability need to be addressed. This multi-site survey highlights the importance of establishing consensus through national professional organizations to inform provider and hospital practices.

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Delirium screening and identification in the pediatric intensive care unit (PICU) can be a diagnostic challenge. Primarily, the burden of screening falls on the bedside nurses, who are juggling countless tasks throughout their shift. The nursing staff at the researcher's institution were concerned that the existing screen, Cornell Assessment for Pediatric Delirium (CAPD), detracted from workflow. The PEdiatric Delirium Scale (PEDS) was developed to accurately identify delirium in children of all developmental abilities and improve nursing workflow. This is a single-center, double-blinded, preliminary exploratory validation study that assesses the feasibility and accessibility of PEDS. This study was performed in a busy 24-bed quaternary PICU serving a diverse, noncardiac patient population. Enrolled patients underwent screening for delirium using the CAPD and PEDS. These results were compared to the gold standard psychiatric evaluation to determine the validity of the novel screen. Finally, the surveyed nurses reviewed their experience with CAPD and PEDS. The primary outcome was to explore the validation of PEDS in the PICU. Using the Youden index, an overall sensitivity of 79% for the detection of delirium (95% confidence interval [CI]: 0.61–0.91) and a specificity of 68% (95% CI: 0.64–0.73) were achieved with an optimal cut-point of 4, on a scale of 0 to 10. PEDS demonstrated a higher predictive value compared to CAPD. Elicited nursing feedback favored PEDS over CAPD, with 86% of respondents citing a shorter time to perform the screen. PEDS is a streamlined tool that can be used to detect pediatric delirium regardless of developmental abilities. Nursing surveys revealed improved workflow when comparing PEDS to CAPD.