Download PDF
J Pediatr Intensive Care
DOI: 10.1055/s-0043-1771346
Original Article

The Development and Preliminary Exploratory Validation of the PEdiatric Delirium Scale: Assessing the Feasibility and Accessibility of a Novel Delirium Scale

Emily C. Dodenhoff 
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
,
Neha Gupta
2   Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States
,
Lauren Craig
3   Division of Pediatric Critical Care, Children's of Alabama, Birmingham, Alabama, United States
,
Marjorie L. Pate
3   Division of Pediatric Critical Care, Children's of Alabama, Birmingham, Alabama, United States
,
Sarah D. Petrusnek
3   Division of Pediatric Critical Care, Children's of Alabama, Birmingham, Alabama, United States
,
Nianlan Yang
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
,
Kimberly Smith
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
,
Allison Woolley
3   Division of Pediatric Critical Care, Children's of Alabama, Birmingham, Alabama, United States
,
Yesie Yoon
4   Department of Child and Adolescent Psychiatry, Montefiore Medical Center, Bronx, New York, United States
,
Tapan Mehta
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
,
Leslie W. Hayes
1   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
› Author Affiliations Funding This study was fully supported by the University of Alabama at Birmingham Department of Pediatrics, Division of Pediatric Critical Care. We would also like to thank the partial financial support provided by the National Institute of Diabetes and Digestive and Kidney Diseases (Grant P30 DK056336).
› Further Information
    Permissions and Reprints

Abstract

Delirium screening and identification in the pediatric intensive care unit (PICU) can be a diagnostic challenge. Primarily, the burden of screening falls on the bedside nurses, who are juggling countless tasks throughout their shift. The nursing staff at the researcher's institution were concerned that the existing screen, Cornell Assessment for Pediatric Delirium (CAPD), detracted from workflow. The PEdiatric Delirium Scale (PEDS) was developed to accurately identify delirium in children of all developmental abilities and improve nursing workflow. This is a single-center, double-blinded, preliminary exploratory validation study that assesses the feasibility and accessibility of PEDS. This study was performed in a busy 24-bed quaternary PICU serving a diverse, noncardiac patient population. Enrolled patients underwent screening for delirium using the CAPD and PEDS. These results were compared to the gold standard psychiatric evaluation to determine the validity of the novel screen. Finally, the surveyed nurses reviewed their experience with CAPD and PEDS. The primary outcome was to explore the validation of PEDS in the PICU. Using the Youden index, an overall sensitivity of 79% for the detection of delirium (95% confidence interval [CI]: 0.61–0.91) and a specificity of 68% (95% CI: 0.64–0.73) were achieved with an optimal cut-point of 4, on a scale of 0 to 10. PEDS demonstrated a higher predictive value compared to CAPD. Elicited nursing feedback favored PEDS over CAPD, with 86% of respondents citing a shorter time to perform the screen. PEDS is a streamlined tool that can be used to detect pediatric delirium regardless of developmental abilities. Nursing surveys revealed improved workflow when comparing PEDS to CAPD.

Keywords

delirium - pediatric intensive care - workflow - developmental delay

Address for reprint: CPPI 102, 1600 7th Ave South, Birmingham, AL 35233




Publication History

Received: 11 May 2023

Accepted: 15 June 2023

Article published online:
28 July 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Traube C, Silver G, Gerber LM. et al. Delirium and mortality in critically ill children: epidemiology and outcomes of pediatric delirium. Crit Care Med 2017; 45 (05) 891-898
    CrossrefPubMedGoogle Scholar
  • 2 Meyburg J, Dill ML, Traube C, Silver G, von Haken R. Patterns of postoperative delirium in children. Pediatr Crit Care Med 2017; 18 (02) 128-133
    CrossrefPubMedGoogle Scholar
  • 3 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: APA Press; 2013
    CrossrefGoogle Scholar
  • 4 Thom R. Pediatric delirium. Am J Psychiatry Resid J 2017; 12: 1-6
    PubMedGoogle Scholar
  • 5 Satiani A, Niedermier J, Satiani B, Svendsen DP. Projected workforce of psychiatrists in the United States: a population analysis. Psychiatr Serv 2018; 69 (06) 710-713
    CrossrefPubMedGoogle Scholar
  • 6 Traube C, Silver G, Kearney J. et al. Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU. Crit Care Med 2014; 42 (03) 656-663
    CrossrefPubMedGoogle Scholar
  • 7 Smith HA, Boyd J, Fuchs DC. et al. Diagnosing delirium in critically ill children: validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit. Crit Care Med 2011; 39 (01) 150-157
    CrossrefPubMedGoogle Scholar
  • 8 Kalvas LB, Harrison TM. State of the science in pediatric ICU delirium: an integrative review. Res Nurs Health 2020; 43 (04) 341-355
    CrossrefPubMedGoogle Scholar
  • 9 Gupta N, Talathi S, Woolley A. et al. Performance of Cornell Assessment of Pediatric Delirium Scale in mechanically ventilated children. J Pediatr Intensive Care 2021; 12 (01) 24-30
    PubMedGoogle Scholar
  • 10 Hu D, Kong Y, Li W. et al. Frontline nurses' burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: a large-scale cross-sectional study. EClinicalMedicine 2020; 24: 100424
    CrossrefPubMedGoogle Scholar
  • 11 Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D. Nurses' burnout and associated risk factors during the COVID-19 pandemic: a systematic review and meta-analysis. J Adv Nurs 2021; 77 (08) 3286-3302
    CrossrefPubMedGoogle Scholar
  • 12 Curley MA, Harris SK, Fraser KA, Johnson RA, Arnold JH. State Behavioral Scale: a sedation assessment instrument for infants and young children supported on mechanical ventilation. Pediatr Crit Care Med 2006; 7 (02) 107-114
    CrossrefPubMedGoogle Scholar
  • 13 Trizano-Hermosilla I, Alvarado JM. Best alternatives to Cronbach's alpha reliability in realistic conditions: congeneric and asymmetrical measurements. Front Psychol 2016; 7: 769-769
    CrossrefPubMedGoogle Scholar
  • 14 Luo J, Xiong C. DiagTest3Grp: an R package for analyzing diagnostic tests with three ordinal groups. J Stat Softw 2012; 51 (03) 1-24
    PubMedGoogle Scholar
  • 15 Malas N, Brahmbhatt K, McDermott C, Smith A, Ortiz-Aguayo R, Turkel S. Pediatric delirium: evaluation, management and special considerations. Curr Psychiatry Rep 2017; 19 (09) 65
    CrossrefPubMedGoogle Scholar
  • 16 Flo J, Landmark B, Hatlevik OE, Fagerström L. Using a new interrater reliability method to test the modified Oulu Patient Classification instrument in home health care. Nurs Open 2018; 5 (02) 167-175
    CrossrefPubMedGoogle Scholar
  • 17 McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012; 22 (03) 276-282
    CrossrefPubMedGoogle Scholar
  • 18 Edwards JD, Houtrow AJ, Vasilevskis EE. et al. Chronic conditions among children admitted to U.S. pediatric intensive care units: their prevalence and impact on risk for mortality and prolonged length of stay. Crit Care Med 2012; 40 (07) 2196-2203
    CrossrefPubMedGoogle Scholar
  • 19 Valdivia HR, Carlin KE. Determining interrater reliability of the cornell assessment of pediatric delirium screening tool among PICU nurses. Pediatr Crit Care Med 2019; 20 (04) e216-e220
    CrossrefPubMedGoogle Scholar
  • 20 Walter HJ, Bukstein OG, Abright AR. et al. Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 2020; 59 (10) 1107-1124
    CrossrefPubMedGoogle Scholar
  • 21 Flaigle MC, Ascenzi J, Kudchadkar SR. Identifying barriers to delirium screening and prevention in the pediatric ICU: evaluation of PICU staff knowledge. J Pediatr Nurs 2016; 31 (01) 81-84
    CrossrefPubMedGoogle Scholar
  • 22 Patel AK, Bell MJ, Traube C. Delirium in pediatric critical care. Pediatr Clin North Am 2017; 64 (05) 1117-1132
    CrossrefPubMedGoogle Scholar