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2014 ; 42
(3
): 656-63
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gab.com Text
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English Wikipedia
Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for
screening delirium in the PICU*
#MMPMID24145848
Traube C
; Silver G
; Kearney J
; Patel A
; Atkinson TM
; Yoon MJ
; Halpert S
; Augenstein J
; Sickles LE
; Li C
; Greenwald B
Crit Care Med
2014[Mar]; 42
(3
): 656-63
PMID24145848
show ga
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 ? 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 ? = 0.94; item range ? = 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.
|*Intensive Care Units, Pediatric
[MESH]
|Adolescent
[MESH]
|Age Distribution
[MESH]
|Child
[MESH]
|Child, Preschool
[MESH]
|Cohort Studies
[MESH]
|Critical Care/methods
[MESH]
|Delirium/*diagnosis/epidemiology
[MESH]
|Diagnostic and Statistical Manual of Mental Disorders
[MESH]