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

Published online by Cambridge University Press:  15 August 2014

Gabrielle Silver ,
Julia Kearney ,
Chani Traube  and
Margaret Hertzig
Gabrielle Silver*
Affiliation:
Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
Julia Kearney
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, New York
Chani Traube
Affiliation:
Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
Margaret Hertzig
Affiliation:
Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
*
Address correspondence and reprint requests to: Gabrielle Silver, Consultation Liaison, Child Psychiatry, Weill Cornell Medical College/New York Presbyterian Hospital, 525 East 68th Street, Box 140, New York, New York 10065. E-mail: ghs2001@med.cornell.edu
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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.

Keywords

DeliriumChild psychiatryPediatric critical careDevelopmental anchor points
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 4 , August 2015 , pp. 1005 - 1011
Copyright
Copyright © Cambridge University Press 2014 

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