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Intensive Care Med. 2009 Nov;35(11):1843-9. doi: 10.1007/s00134-009-1652-8.

Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units.

Author information

  • 1Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, European Graduate School of Neuroscience, SEARCH, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands. jan.schieveld@mumc.nl

Abstract

CONTEXT:

If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required.

OBJECTIVE:

Relating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm.

RESULTS:

Delirium-inducing factors, disturbance of consciousness and inattention are common in PICU patients: a pre-delirious state is present in most. An algorithm is introduced, containing (1) evaluation of the sedation-agitation level, (2) psychometric assessment of behavior and (3) opinion of the caregivers.

DISCUSSION:

It may be argued that the behavioral focus of the algorithm would benefit from the inclusion of neurocognitive measures. Limitations: No sufficiently validated diagnostic instrument covering the entire algorithm is available yet.

CONCLUSION:

This is the first proposal for a PD diagnostic algorithm. Given the high prevalence of predelirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.

PMID:
19771408
[PubMed - indexed for MEDLINE]
PMCID:
PMC2765651
Free PMC Article

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