Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit.
OBJECTIVE
To validate a diagnostic instrument for pediatric delirium in critically ill children, both ventilated and nonventilated, that uses standardized, developmentally appropriate measurements.


METHODS
A prospective observational cohort study investigating the Pediatric Confusion Assessment Method for Intensive Care Unit (pCAM-ICU) patients in the pediatric medical, surgical, and cardiac intensive care unit of a university-based medical center.


METHODS
A total of 68 pediatric critically ill patients, at least 5 years of age, were enrolled from July 1, 2008, to March 30, 2009.


METHODS
None.


METHODS
Criterion validity including sensitivity and specificity and interrater reliability were determined using daily delirium assessments with the pCAM-ICU by two critical care clinicians compared with delirium diagnosis by pediatric psychiatrists using Diagnostic and Statistical Manual, 4th Edition, Text Revision criteria.


RESULTS
A total of 146 paired assessments were completed among 68 enrolled patients with a mean age of 12.2 yrs. Compared with the reference standard for diagnosing delirium, the pCAM-ICU demonstrated a sensitivity of 83% (95% confidence interval, 66-93%), a specificity of 99% (95% confidence interval, 95-100%), and a high interrater reliability (κ = 0.96; 95% confidence interval, 0.74-1.0).


CONCLUSIONS
The pCAM-ICU is a highly valid reliable instrument for the diagnosis of pediatric delirium in critically ill children chronologically and developmentally at least 5 yrs of age. Use of the pCAM-ICU may expedite diagnosis and consultation with neuropsychiatry specialists for treatment of pediatric delirium. In addition, the pCAM-ICU may provide a means for delirium monitoring in future epidemiologic and interventional studies in critically ill children.
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA. heidi.smith@vanderbilt.edu
Heidi A B
HA
Smith
Jenny
J
Boyd
D Catherine
DC
Fuchs
Kelly
K
Melvin
Pamela
P
Berry
Ayumi
A
Shintani
Svetlana K
SK
Eden
Michelle K
MK
Terrell
Tonya
T
Boswell
Karen
K
Wolfram
Jenna
J
Sopfe
Frederick E
FE
Barr
Pratik P
PP
Pandharipande
E Wesley
EW
Ely
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003221:Confusion / Q000175:diagnosis; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D003693:Delirium / Q000175:diagnosis*; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D058027:Neuropsychiatry / Q000592:standards; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011594:Psychometrics; D012015:Reference Standards; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index