Gupta Neha, Talathi Saurabh, Woolley Allison, Wilson Stephanie, Franklin Mildred, Robbins Johanna, Colston Candice, Hayes Leslie
Division of Pediatric Critical Care, Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States.
Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States.
J Pediatr Intensive Care. 2021 Jun 3;12(1):24-30. doi: 10.1055/s-0041-1728784. eCollection 2023 Mar.
Accuracy of delirium diagnosis in mechanically ventilated children is often limited by their varying developmental abilities. The purpose of this study was to examine the performance of the Cornell Assessment of Pediatric Delirium (CAPD) scale in these patients. This is a single-center, prospective, observational study of patients requiring sedation and mechanical ventilation for 2 days or more. CAPD scale was implemented in our unit for delirium screening. Each CAPD assessment was accompanied by a physician assessment using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Sensitivity analysis was performed to determine the best cut-off score in our target population. We also evaluated ways to improve the accuracy of this scale in patients with and without developmental delay. A total of 837 paired assessments were performed. Prevalence of delirium was 19%. Overall, CAPD score ≥ 9 had sensitivity of 81.8% and specificity of 44.8%. Among typically developed patients, the sensitivity and specificity were 76.7 and 65.4%, respectively, whereas specificity was only 16.5% for developmentally delayed patients. The best cut-off value for CAPD was 9 for typically developed children and 17 for those with developmental delay (sensitivity 74.4%, specificity 63.2%). Some CAPD questions do not apply to patients with sensory and neurocognitive deficits; upon excluding those questions, the best cut-off values were 5 for typically developed and 6 for developmentally delayed children. In mechanically ventilated patients with developmental delay, CAPD ≥ 9 led to a high false-positive rate. This emphasizes the need for either a different cut-off score or development of a delirium scale specific to this patient population.
机械通气儿童谵妄诊断的准确性常常受到其不同发育能力的限制。本研究的目的是检验康奈尔儿童谵妄评估（CAPD）量表在这些患者中的性能。这是一项针对需要镇静和机械通气2天或更长时间的患者的单中心、前瞻性观察性研究。CAPD量表在我们科室用于谵妄筛查。每次CAPD评估都伴有医生使用《精神疾病诊断与统计手册》第五版（DSM-V）标准进行的评估。进行敏感性分析以确定我们目标人群中的最佳截断分数。我们还评估了提高该量表在有或无发育迟缓患者中准确性的方法。总共进行了837次配对评估。谵妄的患病率为19%。总体而言，CAPD评分≥9时，敏感性为81.8%，特异性为44.8%。在发育正常的患者中，敏感性和特异性分别为76.7%和65.4%，而发育迟缓患者的特异性仅为16.5%。对于发育正常的儿童，CAPD的最佳截断值为9，对于发育迟缓的儿童为17（敏感性74.4%，特异性63.2%）。一些CAPD问题不适用于有感觉和神经认知缺陷的患者；排除这些问题后，发育正常儿童的最佳截断值为5，发育迟缓儿童为6。在有发育迟缓的机械通气患者中，CAPD≥9导致较高的假阳性率。这强调了需要不同的截断分数或开发针对该患者群体的谵妄量表。
