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Pediatric delirium: Evaluating the gold standard

Published online by Cambridge University Press:  24 April 2014

Gabrielle Silver ,
Julia Kearney ,
Chani Traube ,
Thomas M. Atkinson ,
Katarzyna E. Wyka  and
John Walkup
Gabrielle Silver*
Affiliation:
Weill Cornell Medical College, New York, New York
Julia Kearney
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York, New York
Chani Traube
Affiliation:
Weill Cornell Medical College, New York, New York
Thomas M. Atkinson
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York, New York
Katarzyna E. Wyka
Affiliation:
Weill Cornell Medical College, New York, New York City University of New York, New York, New York
John Walkup
Affiliation:
Weill Cornell Medical College, New York, New York
*
Address correspondence and reprint requests to: Gabrielle Silver, Consultation Liaison Child Psychiatry, Weill Cornell Medical College/New York Presbyterian Hospital, 525 East 68th Street, Box 140, New York, New York 10065. E-mail: [email protected]
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Abstract

Objective:

Our aim was to evaluate interrater reliability for the diagnosis of pediatric delirium by child psychiatrists.

Method:

Critically ill patients (N = 17), 0–21 years old, including 7 infants, 5 children with developmental delay, and 7 intubated children, were assessed for delirium using the Diagnostic and Statistical Manual–IV (DSM–IV) (comparable to DSM–V) criteria. Delirium assessments were completed by two psychiatrists, each blinded to the other's diagnosis, and interrater reliability was measured using Cohen's κ coefficient along with its 95% confidence interval.

Results:

Interrater reliability for the psychiatric assessment was high (Cohen's κ = 0.94, CI [0.83, 1.00]). Delirium diagnosis showed excellent interrater reliability regardless of age, developmental delay, or intubation status (Cohen's κ range 0.81–1.00).

Significance of results:

In our study cohort, the psychiatric interview and exam, long considered the “gold standard” in the diagnosis of delirium, was highly reliable, even in extremely young, critically ill, and developmentally delayed children. A developmental approach to diagnosing delirium in this challenging population is recommended.

Keywords

DeliriumChild psychiatryPediatric critical care
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 3 , June 2015 , pp. 513 - 516
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

American Psychiatric Association (APA) (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM–IV-TR, 4th text revision ed.Washington, DC: American Psychiatric Association.Google Scholar
Barr, J., Fraser, G.L., Puntillo, K., et al. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical Care Medicine, 41, 263–306.Google Scholar
Esseveld, M.M., Leroy, P.L.M.N., Leue, C., et al. (2013). Catatonia and refractory agitation in an updated flowchart for the evaluation of emotional–behavioral disturbances in severely ill children. Intensive Care Medicine, 39, 528–529.Google Scholar
Janssen, N.J., Tan, E.Y., Staal, M., et al. (2011). On the utility of diagnostic instruments for pediatric delirium in critical illness: An evaluation of the Pediatric Anesthesia Emergence Delirium Scale, the Delirium Rating Scale 88, and the Delirium Rating Scale–Revised R-98. Intensive Care Medicine, 37, 1331–1337.Google Scholar
Karnik, N.S., Joshi, S.V., Paterno, C., et al. (2007). Subtypes of pediatric delirium: A treatment algorithm. Psychosomatics, 48, 253–257.Google Scholar
Leentjens, A.F., Schieveld, J.N., Leonard, M., et al. (2008). A comparison of the phenomenology of pediatric, adult, and geriatric delirium. Journal of Psychosomatic Research, 64, 219–223.Google Scholar
Madden, K., Turkel, S., Jacobson, J., et al. (2011). Recurrent delirium after surgery for congenital heart disease in an infant. Pediatric Critical Care Medicine, 12, e413–415.Google Scholar
Schieveld, J.N., Leroy, P.L., van Os, J., et al. (2007). Pediatric delirium in critical illness: Phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit. Intensive Care Medicine, 33, 1033–1040.Google Scholar
Schieveld, J.N., van der Valk, J.A., Smeets, I., et al. (2009). Diagnostic considerations regarding pediatric delirium: A review and a proposal for an algorithm for pediatric intensive care units. Intensive Care Medicine, 35, 1843–1849.Google Scholar
Schieveld, J.N., Staal, M., Voogd, L., et al. (2010). Refractory agitation as a marker for pediatric delirium in very young infants at a pediatric intensive care unit. Intensive Care Medicine, 36, 1982–198.Google Scholar
Sessler, C.N., Gosnell, M.S., Grap, M.J., et al. (2002). The Richmond Agitation–Sedation Scale: Validity and reliability in adult intensive care unit patients. American Journal of Respiratory and Critical Care Medicine, 166, 1338–1344.10.1164/rccm.2107138Google Scholar
Silver, G.H., Kearney, J.A., Kutko, M.C., et al. (2010). Infant delirium in pediatric critical care settings. American Journal of Psychiatry, 167, 1172–1177.Google Scholar
Silver, G., Traube, C., Kearney, J., et al. (2012). Detecting pediatric delirium: Development of a rapid observational assessment tool. Intensive Care Medicine, 38, 1025–1031.Google Scholar
Smith, H.A., Fuchs, D.C., Pandharipande, P.P., et al. (2009). Delirium: An emerging frontier in the management of critically ill children. Critical Care Clinics, 25, 593–614, x.Google Scholar
Smith, H.A.B., Boyd, J., Fuchs, D.C., et al. (2011). Diagnosing delirium in critically ill children: Validity and reliability of the pediatric confusion assessment method for the intensive care unit. Critical Care Medicine, 39, 150–157.Google Scholar
Smith, H.A.B., Brink, E., Fuchs, D.C., et al. (2013). Pediatric delirium: Monitoring and management in the pediatric intensive care unit. Pediatric Clinics of North America, 60, 741–760.10.1016/j.pcl.2013.02.010Google Scholar
Traube, C., Silver, G., Kearney, J., et al. (2013). Cornell Assessment of Pediatric Delirium: A valid, rapid, observational tool for screening delirium in the PICU. Critical Care Medicine, 42(3), 656–663.Google Scholar
Trzepacz, P.T., Mittal, D., Torres, R., et al. (2001). Validation of the Delirium Rating Scale–Revised-98: Comparison with the delirium rating scale and the cognitive test for delirium. The Journal of Neuropsychiatry and Clinical Neurosciences, 13, 229–242.Google Scholar
Turkel, S.B., Braslow, K., Tavare, C.J., et al. (2003). The delirium rating scale in children and adolescents. Psychosomatics, 44, 126–129.Google Scholar
Turkel, S.B., Trzepacz, P.T. & Tavare, C.J. (2006). Comparing symptoms of delirium in adults and children. Psychosomatics, 47, 320–324.Google Scholar
Turkel, S.B., Jacobson, J.R. & Tavaré, C.J. (2013). The diagnosis and management of delirium in infancy. Journal of Child and Adolescent Psychopharmacology, 23, 352–356.Google Scholar