Diagnosing Delirium in a Pediatric Intensive Care Unit. American Academy of Child and Adolescent Psychiatry. October 2017
National Scientific Meeting
Objectives: Delirium, as defined in the DSM-5, is an acute disturbance in
attention and awareness and is a well-described adverse outcome following
adult critical illness. It is less understood in pediatrics. The primary objective of
this study was to evaluate the incidence of delirium in a pediatric intensive
care unit (PICU) and diagnostic associations.
Methods: Children (ages 5–17 years) with an anticipated PICU stay of >24
hours without significant developmental delay or neurologic injury were
recruited. Daily screens for delirium were conducted with the Cornell
Assessment of Pediatric Delirium (CAPD) and Pediatric Confusion Assessment
Method for the ICU (PCAM). Delirium positive children were referred to
psychiatry. All children had cognitive testing done at time of transfer with the
Children’s Memory Scale (CMS). Other medical data were collected via chart
Results: Children (N ¼ 53) were recruited (mean age ¼ 11 years, 51% male),
with a variety of ethnic backgrounds. Forty-two percent of children screened
positive for delirium. Psychiatry confirmed the diagnosis in 54 percent of them
(23% of the total number). Children performed at <50th percentile in all domains of the CMS: 1) attention/concentration (mean ¼ 28.0%ile); 2) visual/
nonverbal memory (mean ¼ 30.9 and 41.7%ile); and 3) auditory/verbal memory (mean ¼ 41.4 and 14.3%ile). There were no group differences based on
age or gender in the screen of children’s delirium; however, children who
screened positive had higher opiate and benzodiazepine use and longer
lengths of stay (t ¼ 4.01, P ¼ 0.00; t ¼ 1.9, P ¼ 0.06; t ¼ 3.7, P ¼ 0.00).
Irrespective of delirium status, both groups performed poorly on the CMS
without significant group differences.
Conclusions: The incidence of delirium in this population was 42 percent by
screener and 23 percent after psychiatric evaluation. The new DSM-5
criteria for delirium focus on cognitive dysfunction. The children in this
study had significantly impaired cognitive function in the diagnostic domains of delirium, regardless of delirium status. Thus, although delirium assessments capture some of the children with delirium, both the screeners
and psychiatry are still missing a significant proportion of children who have
ongoing cognitive dysfunction. Pediatric healthcare needs to improve its
evaluation of delirium to minimize ongoing cognitive deficits after admission to the PICU.
Service Performed By
American Academy of Child and Adolescent Psychiatry