2.35 Addressing Mental Health Needs of Latino Immigrant Parents in Pediatric Primary Care (original) (raw)
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A Clinical Pathway to Standardize Care of Children With Delirium in Pediatric Inpatient Settings
Hospital Pediatrics
Pediatric delirium is an important comorbidity of medical illness in inpatient pediatric care that has lacked a consistent approach for detection and management. A clinical pathway (CP) was developed to address this need. Pediatric delirium contributes significantly to morbidity, mortality, and costs of inpatient care of medically ill children and adolescents. Screening for delirium in hospital settings with validated tools is feasible and effective in reducing delirium and improving outcomes; however, multidisciplinary coordination is required for implementation. The workgroup, composed of international experts in child and adolescent consultation psychiatry, reviewed the literature and developed a flowchart for feasible screening and management of pediatric delirium. When evidence was lacking, expert consensus was reached; stakeholder feedback was included to create the final pathway. A CP expert collaborated with the workgroup. Two sequential CPs were created: (1) "Prevention and Identification of Pediatric Delirium" emphasizes the need for systematic preventive measures and screening, and (2) "Diagnosis and Management of Pediatric Delirium" recommends an urgent and ongoing search for the underlying causes to reverse the syndrome while providing symptomatic management focused on comfort and safety. Detailed accompanying documents explain the supporting literature and the rationale for recommendations and provide resources such as screening tools and implementation guides. Additionally, the role of the child and adolescent consultation-liaison psychiatrist as a resource for collaborative care of patients with delirium is discussed. a NewYork-Presbyterian/Weill
Cornell Assessment of Pediatric Delirium
Critical Care Medicine, 2014
Objective: To determine validity and reliability of the Cornell Assessment of Pediatric Delirium, a rapid observational screening tool. Design: Double-blinded assessments were performed with the Cornell Assessment of Pediatric Delirium completed by nursing staff in the PICU. These ratings were compared with an assessment by consultation liaison child psychiatrist using the Diagnostic and Statistical Manual IV criteria as the "gold standard" for diagnosis of delirium. An initial series of duplicate Cornell Assessment of Pediatric Delirium assessments were performed in blinded fashion to assess interrater reliability. Nurses recorded the time required to complete the Cornell Assessment of Pediatric Delirium screen. Setting: Twenty-bed general PICU in a major urban academic medical center over a 10-week period, March-May 2012. Patients: One hundred eleven patients stratified over ages ranging from 0 to 21 years and across developmental levels. Intervention: Two hundred forty-eight paired assessments completed. Measurements and Main Results: The Cornell Assessment of Pediatric Delirium had an overall sensitivity of 94.1% (95% CI, 83.8-98.8%) and specificity of 79.2% (95% CI, 73.5-84.9%). Overall Cronbach's α of 0.90 was observed, with a range of 0.87-0.90 for each of the eight items, indicating good internal consistency. A scoring cut point of 9 demonstrated good interrater reliability of the Cornell Assessment of Pediatric Delirium when comparing results of the screen between nurses (overall κ = 0.94; item range κ = 0.68-0.78). In patients without significant developmental delay, sensitivity was 92.0% (95% CI, 85.7-98.3%) and specificity was 86.5% (95% CI, 75.4-97.6%). In developmentally delayed children, the Cornell Assessment of Pediatric Delirium showed decreased specificity of 51.2% (95% CI, 24.7-77.8%) but sensitivity remained high at 96.2% (95% CI, 86.5-100%). The Cornell Assessment of Pediatric Delirium takes less than 2 minutes to complete. Conclusions: With an overall prevalence rate of 20.6% in our study population, delirium is a common problem in pediatric critical care. The Cornell Assessment of Pediatric Delirium is a valid, rapid, observational nursing screen that is urgently needed for the detection of delirium in PICU settings.
Pediatric Delirium and Associated Risk Factors
Pediatric Critical Care Medicine, 2015
Objective-To describe a single-institution pilot study regarding prevalence and risk factors for delirium in critically ill children. Design-A prospective observational study, with secondary analysis of data collected during the validation of a pediatric delirium screening tool, the Cornell Assessment of Pediatric Delirium (CAPD). Setting-This study took place in the pediatric intensive care unit (PICU) at an urban academic medical center. Patients-99 consecutive patients, ages newborn to 21 years. Intervention-Subjects underwent a psychiatric evaluation for delirium based on the DSM-IV criteria.
Detecting pediatric delirium: development of a rapid observational assessment tool
Intensive Care Medicine, 2012
Objective: Development of a novel screening tool for the detection of delirium in pediatric intensive care unit (PICU) patients of all ages by comparison with psychiatric assessment based on the reference standard Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Methods: This was a prospective blinded pilot study investigating the feasibility of the Cornell Assessment of Pediatric Delirium (CAP-D) performed in a PICU at a university hospital. Fifty patients, ages 3 months to 21 years, admitted to the PICU over a 6-week period were included. No interventions were performed. Results: After informed consent was obtained, two study teams independently assessed for delirium by completing the CAP-D and by conducting psychiatric evaluation based on the DSM-IV criteria. Concordance between the CAP-D and DSM-IV criteria was excellent, at 97%. Prevalence of delirium in this sample was 29%. Conclusion: The CAP-D may be a valid screen for identification of delirium in PICU patients of all ages. Further studies are required to explore its validity, inter-rater reliability, and feasibility of use as a nursing screen.
Infant Delirium in Pediatric Critical Care Settings
American Journal of Psychiatry, 2010
Pediatric delirium is an important comorbidity of medical illness in inpatient pediatric care that has lacked a consistent approach for detection and management. A clinical pathway (CP) was developed to address this need. Pediatric delirium contributes significantly to morbidity, mortality, and costs of inpatient care of medically ill children and adolescents. Screening for delirium in hospital settings with validated tools is feasible and effective in reducing delirium and improving outcomes; however, multidisciplinary coordination is required for implementation. The workgroup, composed of international experts in child and adolescent consultation psychiatry, reviewed the literature and developed a flowchart for feasible screening and management of pediatric delirium. When evidence was lacking, expert consensus was reached; stakeholder feedback was included to create the final pathway. A CP expert collaborated with the workgroup. Two sequential CPs were created: (1) "Prevention and Identification of Pediatric Delirium" emphasizes the need for systematic preventive measures and screening, and (2) "Diagnosis and Management of Pediatric Delirium" recommends an urgent and ongoing search for the underlying causes to reverse the syndrome while providing symptomatic management focused on comfort and safety. Detailed accompanying documents explain the supporting literature and the rationale for recommendations and provide resources such as screening tools and implementation guides. Additionally, the role of the child and adolescent consultation-liaison psychiatrist as a resource for collaborative care of patients with delirium is discussed.
Acta Anaesthesiologica Scandinavica, 2019
Pediatric Intensive Care Units (PICU's) receive children with severe illness and in urgent need of specialized care. 1 These children are at risk for delirium, a serious medical problem defined as acute cerebral dysfunction caused by systemic disease or the effects of treatment. 2 Several factors can lead to an increased risk of developing pediatric delirium (PD), for example, sight and hearing limitations, fever, infection and sepsis, acidosis, electrolyte displacements, heavy sedation, insertion of a large number of invasive vascular catheters. 3 Delirium can be divided into three types: (a) hyperactive delirium manifested by restlessness, psychomotor hyperactivity, aggression and emotional lability; (b) hypoactive delirium which is an apathetic, lethargic, slow psychomotor responses, with depressive features; (c) mixed delirium, which includes hyper-and hypoactive signs of delirium. 4 Evaluation and treatment of delirium in critically ill children has garnered attention in the world of pediatrics. 5-7 There are only a few international studies on PD and these studies suggest a prevalence rating from 25% to 66%. 7-13 PD is associated with high morbidity and mortality and prolonged lengths of stay in intensive care. 10,14 So far, the evidence on PD in Denmark is limited. 15 It is likely that the actual frequency is significantly higher, as delirium is often missed without routine screening. 7 Thus, valid tools that can measure delirium accurately in a PICU are required to determine prevalence, risk factors, and outcomes. 14 Internationally, there are validated tools to assess PD. 1,14 In recent years three validated PD screening tools have been developed for PICUs: The Pediatric Confusion Assessment Method for the ICU (pCAM-ICU), the Preschool Confusion Assessment Method for the ICU (psCAM-ICU), and the Cornell Assessment of Pediatric Delirium (CAPD). 10,16,17 The pCAM-ICU is an interactive,
Association Between Pediatric Delirium and Quality of Life After Discharge*
Critical Care Medicine, 2020
Objective: Delirium occurs frequently in critically ill children, with highest rates reported in children under 5 years old. The objective of this study was to measure the residual effect of delirium on quality of life at 1 and 3 months after hospital discharge. Design: Prospective observational cohort study. Setting: Urban academic PICU. Patients: Children younger than five years of age at time of admission to the PICU. Interventions: All children were screened for delirium (using the Cornell Assessment for Pediatric Delirium) throughout their stay in the PICU. Quality of life was measured using the Infant-Toddler Quality of Life questionnaire at three time points: baseline, 1 month, and 3 months after hospital discharge. Infant-Toddler Quality of Life scores were compared between children who did and did not develop delirium. Measurements and Main Results: Two hundred seven children were enrolled. One hundred twenty-two completed the 1-month follow-up, and 117 completed the 3-mont...
Archives of Neuroscience
Background: Delirium is often not diagnosed or treated in pediatric intensive care unit (PICU). Delirium leads to a longer hospital stay period, which in turn can result in an increase in hospital treatment costs and an increase in the risk of nosocomial infections. Objectives: The present study aimed to determine the prevalence of delirium and its risk factors in PICU pediatric. Methods: This cross-sectional study was conducted in 2021 - 2022 in hospitals affiliated to Kermanshah University of Medical Sciences. The data collection instruments included the Richmond Agitation-Sedation Scale (RASS) and the Cornell Assessment of Pediatric Delirium (CAPD) questionnaire. Delirium was assessed by the researcher twice a day, in the morning and the evening. The assessment was carried out by a trained person, and the examination results were confirmed by an anesthesiologist who was a member of the research team. Data analysis was carried out using SPSS ver. 16. Results: According to our stud...
Psychosomatics, 2017
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 det...