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Psychosomatics. 2017 Jul - Aug;58(4):355-363. doi: 10.1016/j.psym.2017.03.006. Epub 2017 Mar 15.

Development of the Vanderbilt Assessment for Delirium in Infants and Children to Standardize Pediatric Delirium Assessment By Psychiatrists.

Author information

1
Department of Psychiatry, Monroe Carell Children's Hospital, Vanderbilt University Medical Center, Nashville, TN; Department of Psychiatry, Morgan Stanley Children's Hospital, New York-Presbyterian, Columbia University, New York, NY. Electronic address: mg3569@cumc.columbia.edu.
2
Department of Anesthesiology, Monroe Carell Children's Hospital, Vanderbilt University Medical Center, Nashville, TN; Department of Pediatrics, Monroe Carell Children's Hospital, Vanderbilt University Medical Center, Nashville, TN.
3
National Institutes of Health, National Institute of Mental Health, Bethesda, MD.
4
Weill Cornell Medical Center, New York-Presbyterian, Cornell University, New York, NY.
5
Department of Psychiatry, Arkansas Children's Hospital, University of Arkansas for Medical Science, Little Rock, AK.
6
Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
7
Department of Psychiatry, Boston Children's Hospital, Harvard University, Boston, MA.
8
Department of Psychiatry, Primary Children's Hospital, University of Utah, Salt Lake City, UT.
9
Department of Psychiatry and Behavioral Sciences, Phoenix Children's Hospital, University of Arizona, Phoenix, AZ.
10
Pediatric Hospice and Palliative Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
11
Department of Anesthesiology, Monroe Carell Children's Hospital, Vanderbilt University Medical Center, Nashville, TN.
12
Department of Psychiatry, Monroe Carell Children's Hospital, Vanderbilt University Medical Center, Nashville, TN.

Abstract

BACKGROUND:

Pediatric delirium assessment is complicated by variations in baseline language and cognitive skills, impairment during illness, and absence of pediatric-specific modifiers within the Diagnostic and Statistical Manual of Mental Disorders delirium criterion.

OBJECTIVE:

To develop a standardized approach to pediatric delirium assessment by psychiatrists.

METHODS:

A multidisciplinary group of clinicians used Diagnostic and Statistical Manual criterion as the foundation for the Vanderbilt Assessment for Delirium in Infants and Children (VADIC). Pediatric-specific modifiers were integrated into the delirium criterion, including key developmental and assessment variations for children. The VADIC was used in clinical practice to prospectively assess critically ill infants and children. The VADIC was assessed for content validity by the American Academy of Child and Adolescent Psychiatry Delirium Special Interest Group.

RESULTS:

The American Academy of Child and Adolescent Psychiatry-Delirium Special Interest Group determined that the VADIC demonstrated high content validity. The VADIC (1) preserved the core Diagnostic and Statistical Manual delirium criterion, (2) appropriately paired interactive assessments with key criterion based on development, and (3) addressed confounders for delirium. A cohort of 300 patients with a median age of 20 months was assessed for delirium using the VADIC. Delirium prevalence was 47%.

CONCLUSION:

The VADIC provides a comprehensive framework to standardize pediatric delirium assessment by psychiatrists. The need for consistency in both delirium education and diagnosis is highlighted given the high prevalence of pediatric delirium.

KEYWORDS:

assessment; delirium; education; pediatric; psychiatry; teaching methods

PMID:
28506544
PMCID:
PMC5482775
DOI:
10.1016/j.psym.2017.03.006
[Indexed for MEDLINE]
Free PMC Article

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