Assessment of Pediatric Delirium
Contributed by Sean Barnes, MD, Dale Needham, MD, PhD, and Richard Jones, ScD
Pediatric delirium is increasingly recognized as a frequent and serious complication in hospitalized children.1 Historically, delirium research in the pediatric population has lagged significantly behind mounting evidence in adults. However, awareness of this issue has grown rapidly since the introduction of validated pediatric-specific delirium screening tools. Current research suggests that pediatric delirium occurs most frequently in the pediatric intensive care unit (PICU) and the postoperative care unit.2 For example, a recent international point prevalence study of delirium in the PICU found that 25% of participants screened positive for delirium, and among participants with a PICU length of stay longer than 6 days, the rate increased to 38%.3
Similarly to delirium in adults, pediatric delirium is associated with many adverse outcomes including increased mortality, hospital length of stay, mechanical ventilation duration, and cost of care.4 Features of delirium in the pediatric population may vary by age, but are often similar to those experienced in adults, including disorientation, inattention, agitation and sleep-wake cycle disturbances, as well as hallucinations, aggression, irritability and memory impairment.5
Despite the high prevalence of delirium in hospitalized children, it often goes unrecognized.1 However, since 2011, several instruments for assessing delirium in critically ill children have been developed and validated for use by non-psychiatrists. Recognizing that the pediatric population has differences in neurocognitive and psychosocial development, these instruments use developmentally appropriate tests and stimuli for infants and children, and can be used at the bedside by a member of the pediatric care team.1 Importantly, systematic use of pediatric delirium assessment tools will improve recognition of delirium, allow for implementation of treatment and prevention strategies, and improve understanding of the epidemiology of delirium in children.6 The following information cards provide a standardized summary of these instruments for delirium detection in hospitalized children.
Pediatric Delirium Instrument Info Cards (PDFs)
- Cornell Assessment of Pediatric Delirium (CAPD)
- Pediatric Anesthesia Emergence Delirium Scale (PAED)
- Pediatric Confusion Assessment Method-Intensive Care Unit (pCAM-ICU)
- Preschool Confusion Assessment Method-Intensive Care Unit (psCAM-ICU)
- Sophia Observation Withdrawal Symptoms-Pediatric Delirium (SOS-PD)
About the info cards:
These cards are populated with information from each instrument’s original validation study. Thus, there may be additional test performance characteristics or other information about each instrument that are not included in these cards. Where feasible, we have added selected references to additional review articles that include these instruments.
The info cards were created by the NIDUS Measurement and Harmonization Core (Leaders Richard N. Jones, ScD and Dale M. Needham, MD, PhD), funded by NIA R24AG054259, and are licensed under Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Under this license, you are free to share or adapt these cards for non-commercial purposes with proper attribution. Any adaptations must be shared using the same license.
Requested citation: Network for Investigation of Delirium: Unifying Scientists (NIDUS). 2018. Delirium Measurement Info Cards [Website]. URL: https://deliriumnetwork.org/measurement/delirium-info-cards/
Use of each instrument may be subject to individual copyright, licensing or attribution requirements as specified by the documentation for each individual instruments.
- Patel AK, Bell MJ, Traube C. Delirium in Pediatric Critical Care. Pediatr Clin North Am. 2017;64(5):1117-1132.
- Malas N, Brahmbhatt K, McDermott C, Smith A, Ortiz-Aguayo R, Turkel S. Pediatric Delirium: Evaluation, Management, and Special Considerations. Current psychiatry reports. 2017;19(9):65.
- Traube C, Silver G, Reeder RW, et al. Delirium in Critically Ill Children: An International Point Prevalence Study. Crit Care Med. 2017;45(4):584-590.
- Turkel SB. Pediatric Delirium: Recognition, Management, and Outcome. Current psychiatry reports. 2017;19(12):101.
- Holly C, Porter S, Echevarria M, Dreker M, Ruzehaji S. CE: Original Research Recognizing Delirium in Hospitalized Children A Systematic Review of the Evidence on Risk Factors and Characteristics. AJN The American Journal of Nursing. 2018;118(4):24-36.
- Daoud A, Duff JP, Joffe AR. Diagnostic accuracy of delirium diagnosis in pediatric intensive care: a systematic review. Crit Care. 2014;18(5):489.