Pediatric delirium: evaluating the gold standard.
OBJECTIVE
Our aim was to evaluate interrater reliability for the diagnosis of pediatric delirium by child psychiatrists.


METHODS
Critically ill patients (N = 17), 0-21 years old, including 7 infants, 5 children with developmental delay, and 7 intubated children, were assessed for delirium using the Diagnostic and Statistical Manual-IV (DSM-IV) (comparable to DSM-V) criteria. Delirium assessments were completed by two psychiatrists, each blinded to the other's diagnosis, and interrater reliability was measured using Cohen's κ coefficient along with its 95% confidence interval.


RESULTS
Interrater reliability for the psychiatric assessment was high (Cohen's κ = 0.94, CI [0.83, 1.00]). Delirium diagnosis showed excellent interrater reliability regardless of age, developmental delay, or intubation status (Cohen's κ range 0.81-1.00).


CONCLUSIONS
In our study cohort, the psychiatric interview and exam, long considered the "gold standard" in the diagnosis of delirium, was highly reliable, even in extremely young, critically ill, and developmentally delayed children. A developmental approach to diagnosing delirium in this challenging population is recommended.
Weill Cornell Medical College,New York,New York.
Gabrielle
G
Silver
Memorial Sloan-Kettering Cancer Center,New York,New York.
Julia
J
Kearney
Weill Cornell Medical College,New York,New York.
Chani
C
Traube
Memorial Sloan-Kettering Cancer Center,New York,New York.
Thomas M
TM
Atkinson
Weill Cornell Medical College,New York,New York.
Katarzyna E
KE
Wyka
Weill Cornell Medical College,New York,New York.
John
J
Walkup
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods / Q000523:psychology*; D003693:Delirium / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D007223:Infant; D001523:Mental Disorders; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D055815:Young Adult
Child psychiatry; Delirium; Pediatric critical care