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Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units

CONTEXT: If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required. OBJECTIVE: Relating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm...

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Detalles Bibliográficos
Autores principales: Schieveld, Jan N. M., van der Valk, Judith A., Smeets, Inge, Berghmans, Eline, Wassenberg, Renske, Leroy, Piet L. M. N., Vos, Gijs D., van Os, Jim
Formato: Texto
Lenguaje:English
Publicado: Springer-Verlag 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2765651/
https://www.ncbi.nlm.nih.gov/pubmed/19771408
http://dx.doi.org/10.1007/s00134-009-1652-8
Descripción
Sumario:CONTEXT: If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required. OBJECTIVE: Relating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm. RESULTS: Delirium-inducing factors, disturbance of consciousness and inattention are common in PICU patients: a pre-delirious state is present in most. An algorithm is introduced, containing (1) evaluation of the sedation-agitation level, (2) psychometric assessment of behavior and (3) opinion of the caregivers. DISCUSSION: It may be argued that the behavioral focus of the algorithm would benefit from the inclusion of neurocognitive measures. LIMITATIONS: No sufficiently validated diagnostic instrument covering the entire algorithm is available yet. CONCLUSION: This is the first proposal for a PD diagnostic algorithm. Given the high prevalence of pre-delirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.