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.