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 review. 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

Date

  • October 2017

Host Organization

  • American Academy of Child and Adolescent Psychiatry