Chani Traube1, Gabrielle Silver, Julia Kearney, Anita Patel, Thomas M Atkinson, Margaret J Yoon, Sari Halpert, Julie Augenstein, Laura E Sickles, Chunshan Li, Bruce Greenwald. 1. 1Pediatric Critical Care Medicine, Weill Cornell Medical College, New York, NY. 2Department of Child Psychiatry, Weill Cornell Medical College, New York, NY. 3Department of Pediatrics and Psychiatry, Memorial Sloan-Kettering Cancer Center, New York, NY. 4Department of Pediatrics, NY Presbyterian Hospital, New York, NY. 5Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY. 6Department of Psychiatry, NY Presbyterian Hospital, New York, NY. 7Jefferson Medical College, Philadelphia, PA. 8Department of Public Health, Weill Cornell Medical College, New York, NY.
Abstract
OBJECTIVE: To determine validity and reliability of the Cornell Assessment of Pediatric Delirium, a rapid observational screening tool. DESIGN: Double-blinded assessments were performed with the Cornell Assessment of Pediatric Delirium completed by nursing staff in the PICU. These ratings were compared with an assessment by consultation liaison child psychiatrist using the Diagnostic and Statistical Manual IV criteria as the "gold standard" for diagnosis of delirium. An initial series of duplicate Cornell Assessment of Pediatric Delirium assessments were performed in blinded fashion to assess interrater reliability. Nurses recorded the time required to complete the Cornell Assessment of Pediatric Delirium screen. SETTING: Twenty-bed general PICU in a major urban academic medical center over a 10-week period, March-May 2012. PATIENTS: One hundred eleven patients stratified over ages ranging from 0 to 21 years and across developmental levels. INTERVENTION: Two hundred forty-eight paired assessments completed. MEASUREMENTS AND MAIN RESULTS: The Cornell Assessment of Pediatric Delirium had an overall sensitivity of 94.1% (95% CI, 83.8-98.8%) and specificity of 79.2% (95% CI, 73.5-84.9%). Overall Cronbach's α of 0.90 was observed, with a range of 0.87-0.90 for each of the eight items, indicating good internal consistency. A scoring cut point of 9 demonstrated good interrater reliability of the Cornell Assessment of Pediatric Delirium when comparing results of the screen between nurses (overall κ = 0.94; item range κ = 0.68-0.78). In patients without significant developmental delay, sensitivity was 92.0% (95% CI, 85.7-98.3%) and specificity was 86.5% (95% CI, 75.4-97.6%). In developmentally delayed children, the Cornell Assessment of Pediatric Delirium showed decreased specificity of 51.2% (95% CI, 24.7-77.8%) but sensitivity remained high at 96.2% (95% CI, 86.5-100%). The Cornell Assessment of Pediatric Delirium takes less than 2 minutes to complete. CONCLUSIONS: With an overall prevalence rate of 20.6% in our study population, delirium is a common problem in pediatric critical care. The Cornell Assessment of Pediatric Delirium is a valid, rapid, observational nursing screen that is urgently needed for the detection of delirium in PICU settings.
OBJECTIVE: To determine validity and reliability of the Cornell Assessment of Pediatric Delirium, a rapid observational screening tool. DESIGN: Double-blinded assessments were performed with the Cornell Assessment of Pediatric Delirium completed by nursing staff in the PICU. These ratings were compared with an assessment by consultation liaison child psychiatrist using the Diagnostic and Statistical Manual IV criteria as the "gold standard" for diagnosis of delirium. An initial series of duplicate Cornell Assessment of Pediatric Delirium assessments were performed in blinded fashion to assess interrater reliability. Nurses recorded the time required to complete the Cornell Assessment of Pediatric Delirium screen. SETTING: Twenty-bed general PICU in a major urban academic medical center over a 10-week period, March-May 2012. PATIENTS: One hundred eleven patients stratified over ages ranging from 0 to 21 years and across developmental levels. INTERVENTION: Two hundred forty-eight paired assessments completed. MEASUREMENTS AND MAIN RESULTS: The Cornell Assessment of Pediatric Delirium had an overall sensitivity of 94.1% (95% CI, 83.8-98.8%) and specificity of 79.2% (95% CI, 73.5-84.9%). Overall Cronbach's α of 0.90 was observed, with a range of 0.87-0.90 for each of the eight items, indicating good internal consistency. A scoring cut point of 9 demonstrated good interrater reliability of the Cornell Assessment of Pediatric Delirium when comparing results of the screen between nurses (overall κ = 0.94; item range κ = 0.68-0.78). In patients without significant developmental delay, sensitivity was 92.0% (95% CI, 85.7-98.3%) and specificity was 86.5% (95% CI, 75.4-97.6%). In developmentally delayed children, the Cornell Assessment of Pediatric Delirium showed decreased specificity of 51.2% (95% CI, 24.7-77.8%) but sensitivity remained high at 96.2% (95% CI, 86.5-100%). The Cornell Assessment of Pediatric Delirium takes less than 2 minutes to complete. CONCLUSIONS: With an overall prevalence rate of 20.6% in our study population, delirium is a common problem in pediatric critical care. The Cornell Assessment of Pediatric Delirium is a valid, rapid, observational nursing screen that is urgently needed for the detection of delirium in PICU settings.
Authors: Stephan M Jakob; Esko Ruokonen; R Michael Grounds; Toni Sarapohja; Chris Garratt; Stuart J Pocock; J Raymond Bratty; Jukka Takala Journal: JAMA Date: 2012-03-21 Impact factor: 56.272
Authors: Kevin Madden; Susan Turkel; Julienne Jacobson; David Epstein; David Y Moromisato Journal: Pediatr Crit Care Med Date: 2011-11 Impact factor: 3.624
Authors: Albert F G Leentjens; Jan N M Schieveld; Maeve Leonard; Richel Lousberg; Frans R J Verhey; David J Meagher Journal: J Psychosom Res Date: 2008-02 Impact factor: 3.006
Authors: Juliana Barr; Gilles L Fraser; Kathleen Puntillo; E Wesley Ely; Céline Gélinas; Joseph F Dasta; Judy E Davidson; John W Devlin; John P Kress; Aaron M Joffe; Douglas B Coursin; Daniel L Herr; Avery Tung; Bryce R H Robinson; Dorrie K Fontaine; Michael A Ramsay; Richard R Riker; Curtis N Sessler; Brenda Pun; Yoanna Skrobik; Roman Jaeschke Journal: Crit Care Med Date: 2013-01 Impact factor: 7.598
Authors: Nathalie J J F Janssen; Eva Y L Tan; Marian Staal; Eveline P C J Janssen; Piet L J M Leroy; Richel Lousberg; Jim van Os; Jan N M Schieveld Journal: Intensive Care Med Date: 2011-05-13 Impact factor: 17.440
Authors: Jan N M Schieveld; Piet L J M Leroy; Jim van Os; Joost Nicolai; Gijs D Vos; Albert F G Leentjens Journal: Intensive Care Med Date: 2007-04-25 Impact factor: 17.440
Authors: Pratik P Pandharipande; E Wesley Ely; Rakesh C Arora; Michele C Balas; Malaz A Boustani; Gabriel Heras La Calle; Colm Cunningham; John W Devlin; Julius Elefante; Jin H Han; Alasdair M MacLullich; José R Maldonado; Alessandro Morandi; Dale M Needham; Valerie J Page; Louise Rose; Jorge I F Salluh; Tarek Sharshar; Yahya Shehabi; Yoanna Skrobik; Arjen J C Slooter; Heidi A B Smith Journal: Intensive Care Med Date: 2017-06-13 Impact factor: 17.440
Authors: Gabrielle Silver; Chani Traube; Linda M Gerber; Xuming Sun; Julia Kearney; Anita Patel; Bruce Greenwald Journal: Pediatr Crit Care Med Date: 2015-05 Impact factor: 3.624
Authors: Gabrielle Silver; Julia Kearney; Chani Traube; Thomas M Atkinson; Katarzyna E Wyka; John Walkup Journal: Palliat Support Care Date: 2014-04-24
Authors: Mayur B Patel; Josef Bednarik; Patricia Lee; Yahya Shehabi; Jorge I Salluh; Arjen J Slooter; Kate E Klein; Yoanna Skrobik; Alessandro Morandi; Peter E Spronk; Andrew M Naidech; Brenda T Pun; Fernando A Bozza; Annachiara Marra; Sayona John; Pratik P Pandharipande; E Wesley Ely Journal: Crit Care Med Date: 2018-11 Impact factor: 7.598