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. DESIGN AND SETTING:A prospective observational cohort study investigating the Pediatric Confusion Asse...
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| Veröffentlicht in: | Critical care medicine 2011-01, Vol.39 (1), p.150-157 |
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| creator | Smith, Heidi A. B Boyd, Jenny Fuchs, D. Catherine Melvin, Kelly Berry, Pamela Shintani, Ayumi Eden, Svetlana K Terrell, Michelle K Boswell, Tonya Wolfram, Karen Sopfe, Jenna Barr, Frederick E Pandharipande, Pratik P Ely, E. Wesley |
| description | OBJECTIVE:To validate a diagnostic instrument for pediatric delirium in critically ill children, both ventilated and nonventilated, that uses standardized, developmentally appropriate measurements.
DESIGN AND SETTING: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.
PATIENTS:A total of 68 pediatric critically ill patients, at least 5 years of age, were enrolled from July 1, 2008, to March 30, 2009.
INTERVENTIONS:None.
MEASUREMENTS: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. |
| doi_str_mv | 10.1097/CCM.0b013e3181feb489 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3776416</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>822901648</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5529-8d0dc9ad7dc93f2ccbdfe09133f5d9ed47737eed6edb47803f6223d202b449a83</originalsourceid><addsrcrecordid>eNp9kc1u1DAUhSMEokPhDRDyBrGaYsfJOGaBVIW_Sq1gQdlajn09ueCxW9tpNY_BG5NhhvKzYHOtK3_n3COdqnrK6AmjUrzs-4sTOlDGgbOOORiaTt6rFqzldElrye9XC0olXfJG8qPqUc5fKWVNK_jD6qimspWi44vq-xvU6xAzhjWx4DHhtCEYiElY0GjvtwS9J2ZEbxOEV-SL9mixbIkOlqRZoQf0uz06UkYgn8CiLgkN6WNwU8YYyGnOkPMGQiEXUMZoiYvpJ30WCoSMN0B6nYBcBiyPqwdO-wxPDu9xdfnu7ef-w_L84_uz_vR8adq2lsvOUmuktmKe3NXGDNYBlYxz11oJthGCCwC7Ajs0oqPcreqa25rWQ9NI3fHj6vXe92oaNmDNnC5pr64SbnTaqqhR_f0TcFTreKO4EKuGrWaDFweDFK8nyEVtMBvwXgeIU1ZdXUvKVs3uVLMnTYo5J3B3VxhVuzLVXKb6t8xZ9uzPhHeiX-3NwPMDoPPclUs6GMy_OS4YFWxn1O252-gLpPzNT7eQ1Ajal_H_GX4A4b6_1Q</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>822901648</pqid></control><display><type>article</type><title>Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit</title><source>Journals@Ovid Ovid Autoload</source><source>MEDLINE</source><creator>Smith, Heidi A. B ; Boyd, Jenny ; Fuchs, D. Catherine ; Melvin, Kelly ; Berry, Pamela ; Shintani, Ayumi ; Eden, Svetlana K ; Terrell, Michelle K ; Boswell, Tonya ; Wolfram, Karen ; Sopfe, Jenna ; Barr, Frederick E ; Pandharipande, Pratik P ; Ely, E. Wesley</creator><creatorcontrib>Smith, Heidi A. B ; Boyd, Jenny ; Fuchs, D. Catherine ; Melvin, Kelly ; Berry, Pamela ; Shintani, Ayumi ; Eden, Svetlana K ; Terrell, Michelle K ; Boswell, Tonya ; Wolfram, Karen ; Sopfe, Jenna ; Barr, Frederick E ; Pandharipande, Pratik P ; Ely, E. Wesley</creatorcontrib><description>OBJECTIVE:To validate a diagnostic instrument for pediatric delirium in critically ill children, both ventilated and nonventilated, that uses standardized, developmentally appropriate measurements.
DESIGN AND SETTING: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.
PATIENTS:A total of 68 pediatric critically ill patients, at least 5 years of age, were enrolled from July 1, 2008, to March 30, 2009.
INTERVENTIONS:None.
MEASUREMENTS: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.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0b013e3181feb489</identifier><identifier>PMID: 20959783</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Child ; Child, Preschool ; Clinical death. Palliative care. Organ gift and preservation ; Cohort Studies ; Confusion - diagnosis ; Critical Care - methods ; Critical Illness ; Delirium - diagnosis ; Female ; Humans ; Intensive care medicine ; Intensive Care Units, Pediatric ; Male ; Medical sciences ; Neuropsychiatry - standards ; Observer Variation ; Practice Guidelines as Topic ; Prospective Studies ; Psychometrics ; Reference Standards ; Reproducibility of Results ; Risk Assessment ; Sensitivity and Specificity ; Severity of Illness Index</subject><ispartof>Critical care medicine, 2011-01, Vol.39 (1), p.150-157</ispartof><rights>2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5529-8d0dc9ad7dc93f2ccbdfe09133f5d9ed47737eed6edb47803f6223d202b449a83</citedby><cites>FETCH-LOGICAL-c5529-8d0dc9ad7dc93f2ccbdfe09133f5d9ed47737eed6edb47803f6223d202b449a83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,4010,27900,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23710719$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20959783$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smith, Heidi A. B</creatorcontrib><creatorcontrib>Boyd, Jenny</creatorcontrib><creatorcontrib>Fuchs, D. Catherine</creatorcontrib><creatorcontrib>Melvin, Kelly</creatorcontrib><creatorcontrib>Berry, Pamela</creatorcontrib><creatorcontrib>Shintani, Ayumi</creatorcontrib><creatorcontrib>Eden, Svetlana K</creatorcontrib><creatorcontrib>Terrell, Michelle K</creatorcontrib><creatorcontrib>Boswell, Tonya</creatorcontrib><creatorcontrib>Wolfram, Karen</creatorcontrib><creatorcontrib>Sopfe, Jenna</creatorcontrib><creatorcontrib>Barr, Frederick E</creatorcontrib><creatorcontrib>Pandharipande, Pratik P</creatorcontrib><creatorcontrib>Ely, E. Wesley</creatorcontrib><title>Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:To validate a diagnostic instrument for pediatric delirium in critically ill children, both ventilated and nonventilated, that uses standardized, developmentally appropriate measurements.
DESIGN AND SETTING: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.
PATIENTS:A total of 68 pediatric critically ill patients, at least 5 years of age, were enrolled from July 1, 2008, to March 30, 2009.
INTERVENTIONS:None.
MEASUREMENTS: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.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical death. Palliative care. Organ gift and preservation</subject><subject>Cohort Studies</subject><subject>Confusion - diagnosis</subject><subject>Critical Care - methods</subject><subject>Critical Illness</subject><subject>Delirium - diagnosis</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units, Pediatric</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Neuropsychiatry - standards</subject><subject>Observer Variation</subject><subject>Practice Guidelines as Topic</subject><subject>Prospective Studies</subject><subject>Psychometrics</subject><subject>Reference Standards</subject><subject>Reproducibility of Results</subject><subject>Risk Assessment</subject><subject>Sensitivity and Specificity</subject><subject>Severity of Illness Index</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAUhSMEokPhDRDyBrGaYsfJOGaBVIW_Sq1gQdlajn09ueCxW9tpNY_BG5NhhvKzYHOtK3_n3COdqnrK6AmjUrzs-4sTOlDGgbOOORiaTt6rFqzldElrye9XC0olXfJG8qPqUc5fKWVNK_jD6qimspWi44vq-xvU6xAzhjWx4DHhtCEYiElY0GjvtwS9J2ZEbxOEV-SL9mixbIkOlqRZoQf0uz06UkYgn8CiLgkN6WNwU8YYyGnOkPMGQiEXUMZoiYvpJ30WCoSMN0B6nYBcBiyPqwdO-wxPDu9xdfnu7ef-w_L84_uz_vR8adq2lsvOUmuktmKe3NXGDNYBlYxz11oJthGCCwC7Ajs0oqPcreqa25rWQ9NI3fHj6vXe92oaNmDNnC5pr64SbnTaqqhR_f0TcFTreKO4EKuGrWaDFweDFK8nyEVtMBvwXgeIU1ZdXUvKVs3uVLMnTYo5J3B3VxhVuzLVXKb6t8xZ9uzPhHeiX-3NwPMDoPPclUs6GMy_OS4YFWxn1O252-gLpPzNT7eQ1Ajal_H_GX4A4b6_1Q</recordid><startdate>201101</startdate><enddate>201101</enddate><creator>Smith, Heidi A. B</creator><creator>Boyd, Jenny</creator><creator>Fuchs, D. Catherine</creator><creator>Melvin, Kelly</creator><creator>Berry, Pamela</creator><creator>Shintani, Ayumi</creator><creator>Eden, Svetlana K</creator><creator>Terrell, Michelle K</creator><creator>Boswell, Tonya</creator><creator>Wolfram, Karen</creator><creator>Sopfe, Jenna</creator><creator>Barr, Frederick E</creator><creator>Pandharipande, Pratik P</creator><creator>Ely, E. Wesley</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201101</creationdate><title>Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit</title><author>Smith, Heidi A. B ; Boyd, Jenny ; Fuchs, D. Catherine ; Melvin, Kelly ; Berry, Pamela ; Shintani, Ayumi ; Eden, Svetlana K ; Terrell, Michelle K ; Boswell, Tonya ; Wolfram, Karen ; Sopfe, Jenna ; Barr, Frederick E ; Pandharipande, Pratik P ; Ely, E. Wesley</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5529-8d0dc9ad7dc93f2ccbdfe09133f5d9ed47737eed6edb47803f6223d202b449a83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Clinical death. Palliative care. Organ gift and preservation</topic><topic>Cohort Studies</topic><topic>Confusion - diagnosis</topic><topic>Critical Care - methods</topic><topic>Critical Illness</topic><topic>Delirium - diagnosis</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units, Pediatric</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Neuropsychiatry - standards</topic><topic>Observer Variation</topic><topic>Practice Guidelines as Topic</topic><topic>Prospective Studies</topic><topic>Psychometrics</topic><topic>Reference Standards</topic><topic>Reproducibility of Results</topic><topic>Risk Assessment</topic><topic>Sensitivity and Specificity</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Smith, Heidi A. B</creatorcontrib><creatorcontrib>Boyd, Jenny</creatorcontrib><creatorcontrib>Fuchs, D. Catherine</creatorcontrib><creatorcontrib>Melvin, Kelly</creatorcontrib><creatorcontrib>Berry, Pamela</creatorcontrib><creatorcontrib>Shintani, Ayumi</creatorcontrib><creatorcontrib>Eden, Svetlana K</creatorcontrib><creatorcontrib>Terrell, Michelle K</creatorcontrib><creatorcontrib>Boswell, Tonya</creatorcontrib><creatorcontrib>Wolfram, Karen</creatorcontrib><creatorcontrib>Sopfe, Jenna</creatorcontrib><creatorcontrib>Barr, Frederick E</creatorcontrib><creatorcontrib>Pandharipande, Pratik P</creatorcontrib><creatorcontrib>Ely, E. Wesley</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Smith, Heidi A. B</au><au>Boyd, Jenny</au><au>Fuchs, D. Catherine</au><au>Melvin, Kelly</au><au>Berry, Pamela</au><au>Shintani, Ayumi</au><au>Eden, Svetlana K</au><au>Terrell, Michelle K</au><au>Boswell, Tonya</au><au>Wolfram, Karen</au><au>Sopfe, Jenna</au><au>Barr, Frederick E</au><au>Pandharipande, Pratik P</au><au>Ely, E. Wesley</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2011-01</date><risdate>2011</risdate><volume>39</volume><issue>1</issue><spage>150</spage><epage>157</epage><pages>150-157</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:To validate a diagnostic instrument for pediatric delirium in critically ill children, both ventilated and nonventilated, that uses standardized, developmentally appropriate measurements.
DESIGN AND SETTING: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.
PATIENTS:A total of 68 pediatric critically ill patients, at least 5 years of age, were enrolled from July 1, 2008, to March 30, 2009.
INTERVENTIONS:None.
MEASUREMENTS: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.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>20959783</pmid><doi>10.1097/CCM.0b013e3181feb489</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Critical care medicine, 2011-01, Vol.39 (1), p.150-157 |
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| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Child Child, Preschool Clinical death. Palliative care. Organ gift and preservation Cohort Studies Confusion - diagnosis Critical Care - methods Critical Illness Delirium - diagnosis Female Humans Intensive care medicine Intensive Care Units, Pediatric Male Medical sciences Neuropsychiatry - standards Observer Variation Practice Guidelines as Topic Prospective Studies Psychometrics Reference Standards Reproducibility of Results Risk Assessment Sensitivity and Specificity Severity of Illness Index |
| title | Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit |
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