Accuracy of delirium assessments in critically ill children: A prospective, observational study during routine care

Paterson, Rebecca; Kenardy, Justin; Dow, Belinda; Young, Alexandra De; Pearson, Kylie; Aitken, Leanne M.; Long, Debbie

doi:10.1016/j.aucc.2020.07.012

Cited by 12 publications

(13 citation statements)

References 37 publications

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“…The design of the current study precluded evaluation of the criterion validity of the DIVA Key, and therefore we were unable to determine the sensitivity and specificity, and corresponding positive and negative predictive values, of the DIVA Key in detecting a child’s DIVA status prior to escalation. Given the indicators of DIVA used in the DIVA Key are consistent with other highly sensitive paediatric instruments (e.g., Cornell Assessment of Pediatric Delirium [ 49 , 50 ]), and the results of logistic regression found that first attempt insertion success was lowest in children assessed as high risk of DIVA, however, suggests that the DIVA Key is a promising instrument for the accurate identification of DIVA in this population.…”

Section: Discussionsupporting

confidence: 64%

Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key

Schults

Kleidon

Gibson

et al. 2022

BMC Health Serv Res

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Objective To develop and validate a difficult intravenous access risk assessment and escalation pathway, to increase first time intravenous insertion success in paediatrics. Methods Mixed methods underpinned by literature and co-production principles. Iterative development of the instrument was informed through semi-structured interviews and stakeholder workshops. The instrument includes a risk assessment, inserter skill self-assessment, and escalation pathways. Reproducibility, reliability, and acceptability were evaluated in a prospective cohort study at a quaternary paediatric hospital in Australia. Results Interview data (three parents, nine clinicians) uncovered two themes: i) Recognition of children with DIVA and subsequent escalation is ad hoc and problematic; and ii) Resources and training impact inserter confidence and ability. Three workshops were delivered at monthly intervals (February–April 2020) involving 21 stakeholders culminating in the co-production of the “DIVA Key”. The DIVA Key was evaluated between May–December 2020 in 78 children; 156 clinicians. Seventy-eight paired assessments were undertaken with substantial agreement (concordance range = 81.5 to 83.0%) between the assessors. Interrater reliability of the DIVA risk assessment was moderate (kappa = 0.71, 95% CI 0.63–0.80). The DIVA Key predicted multiple insertion attempts for red (high risk) DIVA classification (relative risk ratio 5.7, 95% CI 1.2–27.1; reference low risk). Consumer and clinician satisfaction with DIVA Key was high (median (IQR) = 10 [8–10]; 8 [8–10 respectively). Conclusion The DIVA Key is a straightforward, reliable instrument with inbuilt escalation pathway to support the identification of children with difficult intravenous access.

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Section: Discussionsupporting

confidence: 64%

Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key

Schults

Kleidon

Gibson

et al. 2022

BMC Health Serv Res

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“…patients were younger (odds ratio [OR] = 1.1; 95% CI 1-1.2) and received any sedation ([OR = 4.1; 95% CI 1.5-11.5) (10). Use of developmental anchor points, not quantified in previous studies, did not improve rater agreement in our study.…”

Section: At the Bedsidecontrasting

confidence: 56%

“…Patients could be assessed on multiple occasions, with at least 3 days in between, to engage as many different nurse raters as possible. We limited the number of assessments per patient to 5, to reduce response bias by overrepresentation of individual subjects (10, 14).…”

Section: Methodsmentioning

confidence: 99%

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Inter-Rater Reliability of Delirium Screening of Infants in the Cardiac ICU: A Prospective, Observational Study

Cleveland¹,

Baute²,

Clindaniel³

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES:To determine the inter-rater reliability (IRR) of the Cornell Assessment for Pediatric Delirium (CAP-D) in infants admitted to a cardiac ICU (CVICU) and to explore the impact of younger age and mechanical ventilation on IRR. DESIGN:Prospective cross-sectional study of delirium screening performed by bedside CVICU nurses. We collected data from September 2020 to April 2021. We evaluated IRR with intraclass correlation coefficient (ICC) one-way random effects and Fleiss kappa for multiple raters. SETTING:Eighteen-bed academic pediatric CVICU.PARTICIPANTS: Subjects: Infants 1 day to 1 year old admitted to the CVICU, stratified in two age groups (≤ 9 wk and 9 wk to < 1 yr). Exclusion criteria were patients' immediate postoperative day, State Behavioral Scale score less than or equal to -2, or at risk for hemodynamic instability with assessment. Raters: CVICU nurses working in the unit during study days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Groups of four raters performed 91 assessments, a total of 364 CAP-D screens. Forty-five of 91 (49%) were in patients less than or equal to 9 weeks old and 43 of 91 (47%) in mechanically ventilated patients. Sixty-eight of 81 nurses (81%) participated. In infants less than or equal to 9 weeks old, ICC was 0.59 (95% CI 0.44-0.71), poor to moderate reliability, significantly lower than the ICC in infants greater than 9 weeks and 0.72 (95% CI 0.61-0.82), moderate to good reliability. In mechanically ventilated infants, ICC was 0.5 (95% CI 0.34-0.65), poor to moderate reliability, significantly lower than the ICC in nonmechanically ventilated infants and 0.69 (95% CI 0.57-0.8), moderate to good reliability. Fleiss kappa for all infants was 0.47 (95% CI 0.34-0.6), slight to fair agreement. Use of anchor points did not improve reliability. CONCLUSIONS:In the youngest, most vulnerable infants admitted to the CVICU, further evaluation of the CAP-D tool is needed.

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“…In one study [4], a delirium rate of 69% was found in patients with a length of stay > 48 hrs (37% of the total sample). Delirium in children leads to adverse outcomes, such as complications, falls, prolonged hospital stay, and prolonged mechanical ventilation and even death [5,6]. Delirium also makes it more likely that the child's cognitive, emotional, and social abilities were impaired after discharge, which makes the caregivers suffering [2,4,7].…”

Section: Overview and Research Significancementioning

confidence: 99%

Risk factors of delirium in paediatric intensive care units: A meta-analysis

et al. 2022

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Background Delirium is a brain dysfunction syndrome, which children have a higher incidence. At present, there have been more and more studies and reports on delirium in paediatric intensive care unit, but there are some differences in the risk factor results among different studies. To better manage delirium, this study was performed. Objective To integrate and clarify the risk factors for delirium in paediatric intensive care unit. Methods CNKI, CBMdisc, Wanfang Data Knowledge Service Platform, VIP, PubMed, Embase, Cochrane Library, JBI and PsycInfo were searched for relevant literature. The study subjects were patients in PICU and literature was included according to the PICOS principle. Literature screening and risk of bias assessment were mainly completed by two researchers, and RevMan 5.3 software and Stata software were used for data analysis. The GRADE systerm was used to assess the quality of evidence. Results A total of 10 studies were included, all in English, involving 4343 children. Within the GRADE system, 4 indicators were scored A, 1 indicators were scored B, and 3 indicators were scored C regarding evidence levels. Three studies analysed the influence of developmental delay on the occurrence of delirium in PICU, total sample size of which was 1823, and the results showed that the combined effect was statistically significant [OR = 3.34, 95%CI(2.46–4.53), Z = 7.75, P<0.001]; Five studies analysed the effects of mechanical ventilation on the occurrence of delirium in PICU, sample size of which was 1562, and the results showed that the combined effect was statistically significant [OR = 4.11, 95%CI(3.13–5.40), Z = 10.16, P<0.001]; Two studies analysed the effects of benzodiazepines on children developing delirium, sample size of which was 1635, and the results showed that the combined effect was statistically significant [OR = 5.05, 95%CI(3.65–6.97), Z = 9.83, P<0.001]; Two studies analysed the effects of anticholinergic drug use on children developing delirium in PICU, sample size of which was 1703, and the results suggested the combined effect was statistically significant [OR = 5.04, 95%CI (3.62–7.00), Z = 9.63, P<0.001]; Two studies compared the same age period, sample size of which was 1724 and the results showed that children 2–5 years old has a 48% incidence rate of delirium relative to children younger than 2 years old, and the combined effect was statistically significant [OR = 0.48, 95%CI(0.25–0.92), Z = 2.22, P = 0.030], children 5–13 years old has a 39% incidence rate of delirium relative to children younger than 2 years old, and the combined effect was statistically significant [OR = 0.39, 95%CI(0.26–0.59), Z = 4.43, P<0.001]. Two studies analysed the effects of PICU LOS on children developing delirium and the combined effect of PICU LOS on the occurrence of delirium in children in PICU was statistically significant [OR = 1.10, 95%CI(1.05–1.15), Z = 4.07, P<0.001]. Conclusion Developmental delay, mechanical ventilation, benzodiazepine use, anticholinergic use, age and PICU length of stay are independent risk factors for delirium in children in PICU. However, only a few articles were included in this study, which may lead to a certain bias and affect the analysing results. More large-sample, multicentre studies should be conducted to further explore and clarify the independent influencing factors of delirium in children in PICU and to provide guidance for clinical practice.

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Accuracy of delirium assessments in critically ill children: A prospective, observational study during routine care

Cited by 12 publications

References 37 publications

Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key

Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key

Inter-Rater Reliability of Delirium Screening of Infants in the Cardiac ICU: A Prospective, Observational Study

Risk factors of delirium in paediatric intensive care units: A meta-analysis

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