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. 2020 Jan;21(1):e39-e46.
doi: 10.1097/PCC.0000000000002183.

Validity and Reliability of the Brazilian Portuguese Version of the Pediatric Confusion Assessment Method for the ICU

Roberta Esteves Vieira de Castro  1   2 , Arnaldo Prata-Barbosa  2 , Maria Clara de Magalhães-Barbosa  2 , Antônio J L A da Cunha  3 , Elie Cheniaux  4   5 , Heidi A B Smith  6
Affiliations

Validity and Reliability of the Brazilian Portuguese Version of the Pediatric Confusion Assessment Method for the ICU

Roberta Esteves Vieira de Castro et al. Pediatr Crit Care Med. 2020 Jan.

Abstract

Objectives: To determine the validity and reliability of the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU for diagnosing delirium in patients with chronological and developmental ages from 5 to 17 years in Brazilian PICUs.

Design: Prospective, cross-sectional study.

Settings: Eight Brazilian PICUs (seven in Rio de Janeiro and one in São Paulo).

Patients: One-hundred sixteen patients, 5-17 years old, without developmental delay, submitted to mechanical ventilation or not.

Interventions: To assess the inter-observer reliability, two previously trained researchers concomitantly applied the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU and independently rated the same patient. To assess the criterion validity, a pediatric neurologist or psychiatrist, blinded to the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU assessments, evaluated the same patient within 30 minutes, using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, considered the reference standard.

Measurements and main results: One-hundred forty-nine paired assessments were included (some patients had more than one). Delirium was diagnosed in 11 of 149 assessments (7%), or eight of 116 patients (7%), using both the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. There was one false positive and one false negative diagnosis, which resulted in 90.9% sensitivity (95% CI, 58.7-99.8%) and 99.3% specificity (95% CI, 96-100%) for the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU. The inter-rater reliability was considered almost perfect (κ = 1.0).

Conclusions: The Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU is a valid and reliable tool for diagnosing delirium in pediatric patients 5-17 years old who are spontaneously breathing and not pharmacologically sedated in Brazilian PICUs. The implementation of this tool may be useful to reduce underdiagnosis, ensure monitoring and earlier intervention, provide a better prognosis, and improve research on delirium in this age group in Brazil. Further studies are necessary to test the psychometric properties of the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU in sedated and mechanically ventilated children.

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Comment in

  • Is Delirium Pediatric Confusion Assessment Method Tools Confiable?
    Caino de Oliveira FR, Ribeiro de Araujo O, Brunow de Carvalho W. Caino de Oliveira FR, et al. Pediatr Crit Care Med. 2020 Apr;21(4):406. doi: 10.1097/PCC.0000000000002284. Pediatr Crit Care Med. 2020. PMID: 32251195 No abstract available.
  • The authors reply.
    de Castro REV, Prata-Barbosa A, de Magalhães-Barbosa MC, da Cunha AJLA, Cheniaux E, Smith HAB. de Castro REV, et al. Pediatr Crit Care Med. 2020 Apr;21(4):407-408. doi: 10.1097/PCC.0000000000002288. Pediatr Crit Care Med. 2020. PMID: 32251196 No abstract available.