delirium monitoring in the pediatric icu · delirium monitoring in the pediatric icu mary hamilton...

PEDIATRIC TOOL VALIDATION INTRODUCTION Delirium Monitoring in the Pediatric ICU Mary Hamilton Chestnut MSN, APN, Heidi AB Smith MD, MSCI Delirium is a disturbance of BOTH cognition and consciousness with the following diagnostic criteria: 1. Acute change or a fluctuating course in patient’s mental status 2. Inattention 3. Change in cognition such as an impaired ability to receive, process, store, or recall information 4. Triggered by a medical or surgical condition Delirium occurs in up to 80% of critically ill adults, and is associated with worse outcomes Absence of large cohort studies on pediatric delirium Review development of the Pediatric and Preschool CAM-ICU tools for diagnosis of delirium in critically ill pediatric patients Review findings and prevalence of delirium in the PICU setting Feature 4: assessed with questions about 24 hour behavior at the bedside Inconsolability Sleep-wake cycle Unawareness Feature 4: Disorganized Thinking Levels of cognitive developmental considered Belief that delirium can be easily diagnosed without a valid bedside tool Belief that delirium recognition will not lead to change in patient management plan Belief that delirium presence will result in removal of all sedatives and analgesics Belief that delirium diagnosis suggests the patient is “crazy” and requires antipsychotics Delirium assessments (Validity): Once daily paired, independent assessments Assessments < 3 hours apart Assessment 1 Using the psCAM/pCAM-ICU Assessment 2 Neuropsychiatric assessment Pediatric delirium is prevalent in the ICU Valid tools such as the pCAM-ICU, psCAM-ICU, and others (PAED, CAP-D) can be used for pediatric delirium monitoring in the ICU Myths regarding delirium can limit use of tools Education is needed to enhance the medical team “buy-in” and effectiveness of pediatric delirium monitoring and management PEDIATRIC TOOL DEVELOPMENT Confusion Assessment Method for the ICU (CAM-ICU) OBJECTIVES Pediatric Confusion Assessment Method for the ICU (pCAM-ICU) Adaptation of the CAM-ICU for patients ≥ 5 years Maintains hierarchal approach for delirium diagnosis Requires presence of inattention Age appropriate adjustments for Features 2 & 4 Feature 2: Inattention Attention screening examination by letters or pictures CAM-ICU pCAM-ICU Preschool Confusion Assessment Method for the ICU (psCAM-ICU) Developed for patients 6 months – 5 years Developed with an interdisciplinary team Adaptation of the pCAM-ICU maintaining objective and direct patient assessments Developmental modifications to Features 2 & 4 Feature 2: Objective assessment using eye contact, tracking, sustained attention, purposeful movements PREVALENCE of PEDIATRIC DELIRIUM Delirium occurs in up to 36% of critically ill pediatric patients Delirium occurs more commonly in infants & children < 2 yrs, reported as high as 46% MYTHS about Delirium and Monitoring CONCLUSIONS The investigators retained full independence in the conduct of this research. The research reported on this poster was supported by the Vanderbilt Institute for Clinical and Translational Research.

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Page 1: Delirium Monitoring in the Pediatric ICU · Delirium Monitoring in the Pediatric ICU Mary Hamilton Chestnut MSN, APN, Heidi AB Smith MD, MSCI Delirium is a disturbance of BOTH cognition

PEDIATRIC TOOL VALIDATION

INTRODUCTION

Delirium Monitoring in the Pediatric ICU

Mary Hamilton Chestnut MSN, APN, Heidi AB Smith MD, MSCI

Delirium is a disturbance of BOTH cognition and consciousness with the following diagnostic criteria: 1. Acute change or a fluctuating course in

patient’s mental status 2. Inattention 3. Change in cognition such as an impaired

ability to receive, process, store, or recall information

4. Triggered by a medical or surgical condition

Delirium occurs in up to 80% of critically ill adults, and is associated with worse outcomes

Absence of large cohort studies on pediatric delirium

Review development of the Pediatric and Preschool CAM-ICU tools for diagnosis of delirium in critically ill pediatric patients

Review findings and prevalence of delirium in the PICU setting

Feature 4: assessed with questions about 24 hour behavior at the bedside

Inconsolability Sleep-wake cycle

Unawareness

Feature 4: Disorganized Thinking Levels of cognitive developmental considered

Belief that delirium can be easily diagnosed without a valid bedside tool Belief that delirium recognition will not lead

to change in patient management plan Belief that delirium presence will result in

removal of all sedatives and analgesics Belief that delirium diagnosis suggests the

patient is “crazy” and requires antipsychotics

Delirium assessments (Validity): Once daily paired, independent assessments Assessments < 3 hours apart Assessment 1 Using the psCAM/pCAM-ICU Assessment 2 Neuropsychiatric assessment

Pediatric delirium is prevalent in the ICU Valid tools such as the pCAM-ICU, psCAM-ICU,

and others (PAED, CAP-D) can be used for pediatric delirium monitoring in the ICU

Myths regarding delirium can limit use of tools Education is needed to enhance the medical

team “buy-in” and effectiveness of pediatric delirium monitoring and management

PEDIATRIC TOOL DEVELOPMENT

Confusion Assessment Method for the ICU (CAM-ICU)

OBJECTIVES

Pediatric Confusion Assessment Method for the ICU (pCAM-ICU)

Adaptation of the CAM-ICU for patients ≥ 5 years Maintains hierarchal approach for delirium diagnosis Requires presence of inattention Age appropriate adjustments for Features 2 & 4

Feature 2: Inattention Attention screening examination by letters or pictures

CAM-ICU pCAM-ICU

Preschool Confusion Assessment Method for the ICU (psCAM-ICU)

Developed for patients 6 months – 5 years Developed with an interdisciplinary team Adaptation of the pCAM-ICU maintaining objective and

direct patient assessments Developmental modifications to Features 2 & 4 Feature 2: Objective assessment using eye contact, tracking, sustained attention, purposeful movements

PREVALENCE of PEDIATRIC DELIRIUM

Delirium occurs in up to 36% of critically ill pediatric patients Delirium occurs more commonly in infants &

children < 2 yrs, reported as high as 46%

MYTHS about Delirium and Monitoring

CONCLUSIONS

The investigators retained full independence in the conduct of this research.

The research reported on this poster was supported by the Vanderbilt Institute for Clinical and Translational Research.

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