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

Smith, Heidi; Boyd, Jenny; Fuchs, Douglas; Melvin, Kelly; Berry, Pamela; Shintani, Ayumi; Eden, Svetlana; Terrell, Michelle K.; Boswell, Tonya; Wolfram, Karen; Sopfe, Jenna; Barr, Frederick E.; Pandharipande, Pratik P.; Ely, E. Wesley

doi:10.1097/ccm.0b013e3181feb489

Cited by 279 publications

(221 citation statements)

References 56 publications

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“…Assessment of disorganized thinking therefore has been modified to include questions that were developmentally appropriate for 5 years old child. pCAM-ICU has been found to have adequate sensitivity (83%) and specificity of 99% and a high interrater reliability (κ value = 0.96) [26] .…”

Section: Paediatrics Cammentioning

confidence: 99%

“…The presence of more behaviors is associated with more severe confusion. The 25 items are divided into 5 subscales, viz., cognition, general behavior, motor response, orientation and psychotic neurotic behaviour [26,27] . In acute care settings, CAC-A has been shown to have high internal consistency (0.80) and high interrater reliability (0.88).…”

Section: Clinical Assessment Of Confusion-a and Bmentioning

confidence: 99%

“…As delirium occurs in medical surgical setting and it is not possible to screen all patients for delirum by mental health 60 August 22, 2012|Volume 2|Issue 4| WJP|www.wjgnet.com Table 1 Scales for assessment of delirium in clinical and research setting Instruments for assessment of arousability of the patient RASS [9] Instruments for screening for premorbid cognitive disturbances IQCODE [10,11] Screening instruments NEECHAM Confusion Scale [12] Nursing Delirium Screening Scale [13] Delirium Observation Screening Scale/Delirium Observation Scale [14,15] Intensive care delirium screening checklist [16] Pediatric Anesthesia Emergence Delirium scale [17] Global Attentiveness Rating [18] Diagnostic instruments Delirium Symptom Interview [19] Saskatoon Delirium Checklist [20] Delirium Rating Scale-revised version [21] Memorial Delirium Assessment Scale [22] Confusion Assessment Method [23] CAM-ICU [24,25] Paediatrics CAM-ICU [26] Clinical Assessment of Confusion -A and B [27,28] Instruments for Assessment of severity of delirium Delirium Rating Scale [29] Delirium Rating Scale-Revised-98 [21] Confusion Assessment Method [23] Confusion Assessment Method for Intensive Care Unit assessment tool [24,25] Delirium-O-Meter [30] Delirium Index [31] Memorial Delirium Assessment Scale [22] Confusional State Evaluation Scale [32] Delirium Assessment Scale [33] Delirium Severity Scale [34] Instruments for assessment of cognitive symptoms only Mini Mental Status Examination [35] Cognitive Test for Delirium [36,37...…”

Section: Screening Instrumentsmentioning

confidence: 99%

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Assessment scales for delirium: A review

Grover

Kate²

2012

WJP

155

128

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Over the years many scales have been designed for screening, diagnosis and assessing the severity of delirium. In this paper we review the various instruments available to screen the patients for delirium, instruments available to diagnose delirium, assess the severity, cognitive functions, motoric subtypes, etiology and associated distress. Among the various screening instruments, NEECHAM confusion scale and delirium observation scale appear to be most suitable screening instrument for patients' in general medical and surgical wards, depending on the type of rater (physician or nurse). In general, the instruments which are used for diagnosis [i.e., confusion assessment method (CAM), CAM for intensive care unit (CAM-ICU), Delirium Rating Scale-revised version (DRS-R-98), memorial selirium assessment scale, etc. ] are based on various Diagnostic and Statistical Manual criteria and have good to excellent reliability and fair to good validity. Among the various diagnostic instruments, CAM is considered to be most useful instrument because of its accuracy, brevity, and ease of use by clinicians and lay interviewers. In contrast, DRS-R-98 appears to be a comprehensive instrument useful for diagnosis, severity rating and is sensitive to change and hence can be used for monitoring patients over a period. In the ICU setting, evidence suggests that CAM-ICU and Nursing Delirium Screening Scale had comparable sensitivities, but CAM-ICU has higher specificity. With regard to assessment of delirium in pediatric age group, certain instruments like Pediatric Anesthesia Emergence Delirium scale and pediatric CAM-ICU has been designed and have been found to be useful.

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Section: Paediatrics Cammentioning

confidence: 99%

Section: Clinical Assessment Of Confusion-a and Bmentioning

confidence: 99%

Section: Screening Instrumentsmentioning

confidence: 99%

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Assessment scales for delirium: A review

Grover

Kate²

2012

WJP

155

128

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“…However, the implications of pediatric delirium in the Japanese context are not well clarified because of the lack of an adequate screening tool. Currently, there are a number of validated and reliable screening tools for delirium used in pediatric ICUs, including the Pediatric Anesthesia Emergence Delirium (PAED) scale,5 the Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM‐ICU),6 and the Cornell Assessment of Pediatric Delirium (CAPD) 7. The pCAM‐ICU can be used only in children over 5 years old, and the PAED scale does not evaluate hypoactive delirium.…”

Section: Introductionmentioning

confidence: 99%

Development of the Japanese version of the Cornell Assessment of Pediatric Delirium

Hoshino

Matsuishi

Shimojo

et al. 2017

Acute Medicine & Surgery

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AimDelirium is a form of acute cerebral dysfunction and is associated with increased length of hospital stay, mortality, and health‐care costs for adult patients in intensive care. However, in Japan, there are currently no reliable criteria or tools for diagnosing delirium in critically ill pediatric patients. The purpose of this study was to translate the Cornell Assessment of Pediatric Delirium (CAPD)—a screening tool for pediatric delirium—from English to Japanese for use in the diagnosis of delirium for pediatric patients in pediatric intensive care units.MethodsThe back‐translation method was used to ensure equivalence in the Japanese version of the CAPD and its accompanying developmental anchor points. The translation process was repeated by a multidisciplinary committee of medical researchers and clinicians.ResultsThe final back‐translated version of the CAPD was submitted to the original author, who gave her approval.ConclusionThe Japanese CAPD was developed and its effectiveness tested using a standardized procedure. Further study is required to test the validity and reliability of the Japanese version of the CAPD.

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“…2,[4][5][6][7] Disturbances in sleep continuity may be associated with an increased risk for delirium in patients admitted to the ICU. [8][9][10][11] Critical illness implies the need for invasive medical instrumentation and frequent interruptions for nursing care and monitoring. However, modifying the external environment can help optimize the sleep experience and potentially decrease a child's sedation needs during mechanical ventilation.…”

mentioning

confidence: 99%