Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units

Context 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. Discussion It may be argued that the behavioral focus of the algorithm would benefit from the inclusion of neurocognitive measures. Limitations No sufficiently validated diagnostic instrument covering the entire algorithm is available yet. Conclusion This is the first proposal for a PD diagnostic algorithm. Given the high prevalence of pre-delirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.