Journal
INTENSIVE CARE MEDICINE
Volume 35, Issue 11, Pages 1843-1849Publisher
SPRINGER
DOI: 10.1007/s00134-009-1652-8
Keywords
Delirium; Critical illness; Sickness behavior; Pediatric intensive care unit (PICU); Diagnosis; Children; DSM-IV; RASS; PAED; CAM-ICU
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If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required. Relating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm. Delirium-inducing factors, disturbance of consciousness and inattention are common in PICU patients: a pre-delirious state is present in most. An algorithm is introduced, containing (1) evaluation of the sedation-agitation level, (2) psychometric assessment of behavior and (3) opinion of the caregivers. It may be argued that the behavioral focus of the algorithm would benefit from the inclusion of neurocognitive measures. No sufficiently validated diagnostic instrument covering the entire algorithm is available yet. This is the first proposal for a PD diagnostic algorithm. Given the high prevalence of pre-delirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.
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