Gangopadhyay Maalobeeka, Smith Heidi, Pao Maryland, Silver Gabrielle, Deepmala Deepmala, De Souza Claire, Garcia Georgina, Giles Lisa, Denton Danica, Jacobowski Natalie, Pandharipande Pratik, Fuchs Catherine
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.
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.
Psychosomatics. 2017 Jul-Aug;58(4):355-363. doi: 10.1016/j.psym.2017.03.006. Epub 2017 Mar 15.
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.
To develop a standardized approach to pediatric delirium assessment by psychiatrists.
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.
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%.
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.
小儿谵妄评估因基线语言和认知技能的差异、疾病期间的损伤以及《精神疾病诊断与统计手册》谵妄标准中缺乏针对儿童的修正因素而变得复杂。
制定一种由精神科医生进行小儿谵妄评估的标准化方法。
一组多学科临床医生以《精神疾病诊断与统计手册》标准为基础，制定了婴幼儿及儿童谵妄的范德比尔特评估法（VADIC）。针对儿童的修正因素被纳入谵妄标准，包括儿童关键的发育和评估差异。VADIC在临床实践中用于前瞻性评估危重症婴幼儿及儿童。美国儿童与青少年精神病学会谵妄特别兴趣小组对VADIC的内容效度进行了评估。
美国儿童与青少年精神病学会谵妄特别兴趣小组认定VADIC具有较高的内容效度。VADIC（1）保留了《精神疾病诊断与统计手册》谵妄标准的核心内容，（2）根据发育情况将交互式评估与关键标准进行了适当配对，（3）解决了谵妄的混杂因素。使用VADIC对300名中位年龄为20个月的患者进行了谵妄评估。谵妄患病率为47%。
VADIC为精神科医生标准化小儿谵妄评估提供了一个全面的框架。鉴于小儿谵妄的高患病率，强调了谵妄教育和诊断一致性的必要性。
