Department of Neonatology, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark.
Department of Intensive Care, Copenhagen University Hospital Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark; University of Copenhagen, Department of Clinical Medicine Copenhagen, Denmark.
Aust Crit Care. 2024 May;37(3):400-406. doi: 10.1016/j.aucc.2023.04.001. Epub 2023 May 8.
Paediatric delirium (PD) is increasingly recognised as a common disorder in critically ill children with a reported prevalence ranging from 9% to 66%. We validated the PD component of the Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale in a Danish setting to provide increased awareness and reliable identification of this critical condition, thereby paving the way for improved pathways to targeted delirium care.
The objectives of this study were to criterion validate the PD component of the SOS-PD screening tool by comparing blinded psychiatric and nurse assessments and to estimate the prevalence of delirium in critically ill children in a Danish context.
A prospective observational study was performed on critically ill children aged between 3 m and 18 y, admitted to an intensive care unit, with a hospital stay of 48 h or more. Assessments took place on a fixed weekday over an 18-month period. To test accuracy and criterion validity, bedside nurses' SOS-PD assessments were compared to the reference standard, a diagnostic assessment performed by a child psychiatrist according to the Diagnostic and Statistical Manual-V criteria by use of the Vanderbilt Assessment of Delirium in Infants and Children.
We included 141 children in the study, 30 (21%) of whom were diagnosed with delirium by the child psychiatrist. The accuracy of the delirium diagnosis was 93.6% (95% confidence interval [CI]: 88.3-97.1) among the nurses' SOS-PD assessments compared to the reference standard. The SOS-PD demonstrated a high sensitivity of 83.3% (95% CI: 65.3-94.4) and a high specificity of 96.4% (95% CI: 91.0-99.0) with five false-negative and four false-positive cases.
The PD component of the SOS-PD tool has good accuracy and validity for assessments performed by nurses compared to a child psychiatrist's diagnosis in critically ill children in a Danish setting. We recommend the use of the SOS-PD instrument in clinical practice.
儿科谵妄（PD）在危重病儿童中越来越被认为是一种常见疾病，其发病率报告范围为 9%至 66%。我们在丹麦环境中验证了 Sophia Observation withdrawal Symptoms-Paediatric Delirium（SOS-PD）量表的 PD 分量表，以提高对这种危急情况的认识并进行可靠识别，从而为改善针对谵妄的护理途径铺平道路。
本研究的目的是通过比较盲法精神科医生和护士评估来对 SOS-PD 筛查工具的 PD 分量表进行标准验证，并估计丹麦背景下危重病儿童的谵妄患病率。
对年龄在 3 个月至 18 岁之间、入住重症监护病房、住院时间超过 48 小时的危重病儿童进行前瞻性观察性研究。评估在 18 个月的固定周内进行。为了测试准确性和标准验证，床边护士的 SOS-PD 评估与参考标准进行了比较，参考标准是根据《精神障碍诊断与统计手册》第五版标准，由儿童精神科医生使用 Vanderbilt 婴儿和儿童谵妄评估进行的诊断评估。
本研究共纳入 141 例儿童，其中 30 例（21%）被儿童精神科医生诊断为谵妄。与参考标准相比，护士 SOS-PD 评估的谵妄诊断准确率为 93.6%（95%置信区间[CI]：88.3-97.1）。SOS-PD 具有较高的灵敏度 83.3%（95% CI：65.3-94.4）和特异性 96.4%（95% CI：91.0-99.0），假阴性 5 例，假阳性 4 例。
在丹麦环境中，与儿童精神科医生的诊断相比，SOS-PD 工具的 PD 分量表对于护士的评估具有较好的准确性和有效性。我们建议在临床实践中使用 SOS-PD 工具。
