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. 2021 Feb 17;21(1):87.
doi: 10.1186/s12887-021-02538-x.

The diagnostic threshold of Cornell assessment of pediatric delirium in detection of postoperative delirium in pediatric surgical patients

Hong Hong  1 , Chao Guo  1 , Zhi-Hua Liu  1 , Bo-Jie Wang  2 , Shu-Zhe Zhou  3 , Dong-Liang Mu  1 , Dong-Xin Wang  1
Affiliations

The diagnostic threshold of Cornell assessment of pediatric delirium in detection of postoperative delirium in pediatric surgical patients

Hong Hong et al. BMC Pediatr. .

Abstract

Background: Cornell assessment of pediatric delirium (CAPD) showed advantage in diagnosis of pediatric delirium in Chinese critically ill patients. But its performance in surgical patients is still unclear. The present study was designed to validate the diagnostic performance of CAPD in surgical pediatric patients.

Methods: This is a prospective validation study. Pediatric patients who underwent selective surgery and general anesthesia were enrolled. Primary outcome was the incidence of delirium within postoperative three days. CAPD Chinese version was used to evaluate if the patient had delirium one time per day. At the meantime, a psychiatrist employed Diagnostic and Statistical Manual of Mental Disorders fifth edition to diagnose delirium, which was the "gold standard", and the result was considered as reference standard. Sensitivity, specificity and area under receiver operating characteristic (ROC) curve were calculated to investigate the performance of CAPD.

Results: A total of 170 patients were enrolled. Median age was 4 years old. As diagnosed by psychiatrist, 23 (13.5 %) patients experienced at least one episode of delirium during the follow-up period. When diagnostic threshold was set at 9, CAPD showed the optimal sensitivity (87.0 %, 95 %CI 65.3 %-96.6 %) and specificity (98.0 %, 95 %CI 93.7 %-99.5 %) in comparison with other diagnostic thresholds. ROC analysis showed that CAPD was a good delirium assessment instrument with area under curve of 0.911 (95 % CI 0.812 to 1.000, P < 0.001). Agreement between CAPD and reference standard was 0.849 (Kappa coefficient, P < 0.001).

Conclusions: This study found that Cornell assessment of pediatric delirium could be used as an effective instrument in diagnosis of delirium in pediatric surgical patients.

Trial registration: www.chictr.org.cn Identifier: ChiCTR-DDD-17,012,231, August 3, 2017.

Keywords: Chinese version; Cornell assessment of pediatric delirium; Pediatric delirium; Surgery; Threshold.

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Conflict of interest statement

The authors declare that they have no conflict of interests.

Figures

Fig. 1
Fig. 1
Flowchart
Fig. 2
Fig. 2
Daily prevalence of delirium
Fig. 3
Fig. 3
Incidence of delirium at different age groups
Fig. 4
Fig. 4
Receiver operating characteristic curve
See this image and copyright information in PMC

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