Delirium screening anchored in child development: The Cornell Assessment for Pediatric Delirium

Abstract

Objective The recently validated Cornell Assessment for Pediatric Delirium (CAPD) is a new rapid bedside nursing screen for delirium in hospitalized children of all ages. The present manuscript provides a “developmental anchor points” reference chart, which helps ground clinicians’ assessment of CAPD symptom domains in a developmental understanding of the presentation of delirium. Method During the development of this CAPD screening tool, it became clear that clinicians need specific guidance and training to help them draw on their expertise in child development and pediatrics to improve the interpretative reliability of the tool and its accuracy in diagnosing delirium. The developmental anchor points chart was formulated and reviewed by a multidisciplinary panel of experts to evaluate content validity and include consideration of sick behaviors within a hospital setting. Results The CAPD developmental anchor points for the key ages of newborn, 4 weeks, 6 weeks, 8 weeks, 28 weeks, 1 year, and 2 years served as the basis for training bedside nurses in scoring the CAPD for the validation trial and as a multifaceted bedside reference chart to be implemented within a clinical setting. In the current paper, we discuss the lessons learned during implementation, with particular emphasis on the importance of collaboration with the bedside nurse, the challenges of establishing a developmental baseline, and further questions about delirium diagnosis in children. Significance of Results The CAPD with developmental anchor points provides a validated, structured, and developmentally informed approach to screening and assessment of delirium in children. With minimal training on the use of the tool, bedside nurses and other pediatric practitioners can reliably identify children at risk for delirium.

Detection and Management of Delirium in the Neonatal Unit: A Case Series

“…Our nurses used the companion Developmental Anchor Points chart to help interpret the infants' behavior in the context of reasonable developmental expectations for a seriously ill infant (Appendix 2). 10 As our cases suggest, considering delirium in the differential diagnosis for the agitated infant in the NICU can lead to increased patient comfort and a decrease in sedation (rather than an escalation in response to agitation). All medications have adverse effects, and there is growing concern regarding the impact of benzodiazepines and opiates in the developing brain.…”

“…10 Even in the first 6 to 8 weeks of life, neonates have predictable normal levels of consciousness (eg, alertness, eye contact, awareness of surroundings) and cognition (eg, attention, memory). With education and increased index of suspicion, we can begin to recognize delirium in the NICU.…”

Diagnosis and Management of Delirium in Critically Ill Infants: Case Report and Review

“…5 The Cornell Assessment of Pediatric Delirium is a developmentally sensitive observational tool for use in a broader age range. 3 Once diagnosed, treatment of infant delirium remains a challenge. General principles of treatment should include environmental interventions (access to natural light during the day and darkness at night, frequent orientation, presence of familiar objects/people, sleep hygiene), limiting events/medications that may worsen delirium 23 implemented in parallel to treatment of underlying causes of delirium.…”

“…2 How this applies to children has been a subject of much interest and research. [3][4][5][6] The available evidence in children is largely based on case reports/ series and retrospective studies with a lack of prospective trials to assess efficacy of interventions, including medications. Patients in abstract Delirium in children is common but not widely understood by pediatric practitioners, often leading to underdiagnosis and lack of treatment.…”

Development of the Japanese version of the Cornell Assessment of Pediatric Delirium

“…In contrast, the CAPD is designed for children of all ages and can be used to assess hypoactive delirium. The CAPD is designed to give nurses a quick and easy way to screen for pediatric patients at risk of delirium 8. It consists of eight question items that correlate with the diagnostic domains of awareness and cognition.…”