Diagnostic accuracy of delirium diagnosis in pediatric intensive care: a systematic review

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• 作者：Alia Daoud (1)
  Jonathan P Duff (1) (2)
  Ari R Joffe (1) (2) (3)
  for the Alberta Sepsis Network
  
  1. Faculty of Medicine and Dentistry ; University of Alberta ; 8440 112 Street ; Edmonton ; AB ; T6G 2B7 ; Canada
  2. Department of Pediatrics ; Stollery Children鈥檚 Hospital and University of Alberta ; 8440 112 Street ; Edmonton ; AB ; T6G 2B7 ; Canada
  3. Department of Pediatrics ; 4-546 Edmonton Clinic Health Academy ; 11405 87 Avenue ; Edmonton ; AB ; T6G 1C9 ; Canada
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：October 2014
• 年：2014
• 卷：18
• 期：5
• 全文大小：275 KB
• 参考文献：Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, Washington, DC
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Delirium is common in adult intensive care, with validated tools for measurement, known risk factors and adverse neurocognitive outcomes. We aimed to determine what is known about pediatric delirium in the pediatric intensive care unit (PICU). Methods We conducted a systematic search for and review of studies of the accuracy of delirium diagnosis in children in the PICU. Secondary aims were to determine the prevalence, risk factors and outcomes associated with pediatric delirium. We created screening and data collection tools based on published recommendations. Results After screening 145 titles and abstracts, followed by 35 full-text publications and reference lists of included publications, 9 reports of 5 studies were included. Each of the five included studies was on a single index test: (1) the Pediatric Anesthesia Emergence Delirium Scale (PAED; for ages 1 to 17聽years), (2) the Pediatric Confusion Assessment Method for the Intensive Care Unit (p-CAM-ICU; for ages 鈮?聽years), (3) the Cornell Assessment of Pediatric Delirium (CAP-D; a modification of the PAED designed to detect hypoactive delirium), (4) the revised Cornell Assessment of Pediatric Delirium (CAP-D(R)) and (5) clinical suspicion. We found that all five studies had a high risk of bias on at least one domain in the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Sample size, sensitivity, specificity, and effectiveness (correct classification divided by total tests done) were: PAED 144, 91%, 98%, 16% of scores required imputation for missing data); p-CAM 68, 78%, 98%, 96%; CAP-D 50, 91%, 100%, 89%; CAP-D (R) 111, and of assessments 94%, 79%, Conclusion High-quality research to determine the accuracy of delirium screening tools in the PICU are required before prevalence, risk factors and outcomes can be determined and before a routine screening tool can be recommended. Direct comparisons of the p-CAM-ICU and CAP-D(R) should be performed.