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

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.

A Systematic Review and Pooled Prevalence of Delirium in Critically Ill Children*

“…Study information on the prevalence of PD is presented in Supplementary Table 1 (http://links.lww.com/CCM/G668). Prevalence was reported per patient ( n = 23) (19–22, 36–39, 41–46, 48–52, 56–59), per assessment ( n = 4) (18, 40, 47, 53), or both ( n = 4) (16, 35, 54, 55). Prevalence of PD using the CAPD tool ranged from 17% to 66% (18, 36–38, 40, 41, 43–46, 48, 50, 51, 53–59), 7% to 54% using age appropriate CAM-ICU (16, 19, 20, 35, 39, 47, 49, 52), and 10% to 25% using the SOS-PD (21, 22, 42).…”

“…Prevalence was reported per patient ( n = 23) (19–22, 36–39, 41–46, 48–52, 56–59), per assessment ( n = 4) (18, 40, 47, 53), or both ( n = 4) (16, 35, 54, 55). Prevalence of PD using the CAPD tool ranged from 17% to 66% (18, 36–38, 40, 41, 43–46, 48, 50, 51, 53–59), 7% to 54% using age appropriate CAM-ICU (16, 19, 20, 35, 39, 47, 49, 52), and 10% to 25% using the SOS-PD (21, 22, 42). A pooled PD prevalence of 34% (95% CI, 27–41) was estimated from 17 studies that reported prevalence per patient using CAPD ( Fig.…”

“…Eleven studies reported on the prevalence of PD subclasses (19, 22, 35, 36, 41, 43, 49, 51, 52, 57, 59). Of these, eight reported hypoactive PD as most prevalent (46–81%) (19, 35, 36, 43, 49, 51, 52, 57).…”

“…Eleven studies reported on the prevalence of PD subclasses (19, 22, 35, 36, 41, 43, 49, 51, 52, 57, 59). Of these, eight reported hypoactive PD as most prevalent (46–81%) (19, 35, 36, 43, 49, 51, 52, 57). Each of the three other studies reported either hyperactive (44%) (22), mixed (57%), or equal percentages of hypoactive and mixed delirium (43%) (59), as most prevalent.…”

2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility

“…Delirium is highly prevalent (reported rates up to 80%) across the spectrum of disease states in the PICU and its development should be considered a possibility in all critically ill pediatric patients (113,152,(221)(222)(223)(224)(225)(226)(227)(228)(229)(230)(231)(232)(233)(234)(235)(236). Multiple studies have determined key risk factors for ICU delirium in pediatric patients.…”