title: Diagnostic considerations regarding  pediatric delirium: a review and a proposal  for an algorithm for pediatric intensive care  units.
abstract: BACKGROUND
  If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required.
  
  
  OBJECTIVE
  Relating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm.
  
  
  RESULTS
  Delirium-inducing factors, disturbance of consciousness and inattention are common in PICU patients: a pre-delirious state is present in most. An algorithm is introduced, containing (1) evaluation of the sedation-agitation level, (2) psychometric assessment of behavior and (3) opinion of the caregivers.
  
  
  CONCLUSIONS
  It may be argued that the behavioral focus of the algorithm would benefit from the inclusion of neurocognitive measures.
  
  
  CONCLUSIONS
  No sufficiently validated diagnostic instrument covering the entire algorithm is available yet.
  
  
  CONCLUSIONS
  This is the first proposal for a PD diagnostic algorithm. Given the high prevalence of predelirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.
authors.affiliation: Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, European Graduate School of Neuroscience, SEARCH, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands. jan.schieveld@mumc.nl
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Schieveld
authors.forename: Judith A
authors.initials: JA
authors.lastname: van der Valk
authors.forename: Inge
authors.initials: I
authors.lastname: Smeets
authors.forename: Eline
authors.initials: E
authors.lastname: Berghmans
authors.forename: Renske
authors.initials: R
authors.lastname: Wassenberg
authors.forename: Piet L M N
authors.initials: PL
authors.lastname: Leroy
authors.forename: Gijs D
authors.initials: GD
authors.lastname: Vos
authors.forename: Jim
authors.initials: J
authors.lastname: van Os
mesh_terms: D000367:Age Factors; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003244:Consciousness Disorders / Q000175:diagnosis / Q000209:etiology; D003422:Critical Care / Q000379:methods*; D003663:Decision Trees; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D042241:Early Diagnosis; D006801:Humans; D015278:Intensive Care Units, Pediatric; D010147:Pain Measurement; D010372:Pediatrics / Q000379:methods; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D055986:Vital Signs