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Review
. 2009 Nov;35(11):1843-9.
doi: 10.1007/s00134-009-1652-8.

Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units

Jan N M Schieveld  1 , Judith A van der Valk, Inge Smeets, Eline Berghmans, Renske Wassenberg, Piet L M N Leroy, Gijs D Vos, Jim van Os
Affiliations
Review

Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units

Jan N M Schieveld et al. Intensive Care Med. 2009 Nov.

Abstract

Context: 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.

Objective: Relating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm.

Results: 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.

Discussion: It may be argued that the behavioral focus of the algorithm would benefit from the inclusion of neurocognitive measures.

Limitations: No sufficiently validated diagnostic instrument covering the entire algorithm is available yet.

Conclusion: This is the first proposal for a PD diagnostic algorithm. Given the high prevalence of predelirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.

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Figures

Fig. 1
Fig. 1
Evaluation and management of emotional–behavioral disturbances at the PICU
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