Validation of the PreSchool Confusion Assessment Method for the Intensive Care Unit (psCAM-ICU)

Vanderbilt University300 enrolled

Overview

The investigators hypothesize that critical care trained registered nurses and physicians can perform measurements of cognitive impairment in critically ill pediatric patients in a reliable and valid manner. To test this hypothesis, the investigators will incorporate an instrument (psCAM-ICU) to assess both components of consciousness, arousal and content, in critically ill pediatric patients at least 6 months to children 5 years of age, both on and off mechanical ventilation, and compare these assessments to those of the reference standard.

Study Type

OBSERVATIONAL

Enrollment

300

Conditions

Delirium Cognitive Impairment

Eligibility

Sex: ALLMin age: 6 MonthsMax age: 5 Years

Medical Language ↔ Plain English

Inclusion Criteria: * All patients admitted to the Pediatric Critical Care Unit regardless of admitting diagnosis aged at least 6 months of age up to 5 years of age. * Patients ventilated or non-ventilated. Exclusion Criteria: * Non-English speaking patients. * Children with visual or hearing impairments. * Patient/surrogate or physician refusal * Moribund and not expected to survive \>48 hours * Patients in whom comfort care orders have been instituted * Patients who are identified for transfer to floor or home regardless of placed orders or bed availability

Outcomes

Primary Outcomes

Validation of psCAM-ICU

The investigators will validate the psCAM-ICU against a reference standard delirium assessment in critically ill infants and young children. Critical care physicians and registered nurses will use the psCAM-ICU to determine presence or absence of delirium once daily in critically ill infants and young children from 6 months to less than 5 years of age. The reference standard, a pediatric delirium expert (child psychiatrist or equivalent), will independently evaluate the same patients for presence or absence of delirium using the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) as the foundation of assessment.

Time frame: Participants will be followed for the duration of hospital stay, an expected average of 2 weeks

Secondary Outcomes

Inter-rater reliability of diagnosing delirium

The investigators will assess inter-rater reliability between physician, practitioner, and nursing assessment using the psCAM-ICU. The psCAM-ICU should consistently diagnose delirium in the critically ill pediatric patient, independent of the type of medical care provider assessing the patient.

Time frame: Participants will be followed for the duration of hospital stay, an expected average of 2 weeks

Validation of the Richmond Agitation Sedation Scale (RASS)

The investigators will validate the RASS against the Glasgow Coma Scale in critically ill infants and young children less than 5 years of age.

Time frame: Participants will be followed for the duration of hospital stay, an expected average of 2 weeks

Validation of the Withdrawal Assessment Tool-1 (WAT-1)

The investigators will validate the WAT-1 against a reference standard (child psychiatrist) in critically ill infants and young children less than 5 years of age.

Time frame: Participants will be followed for the duration of hospital stay, an expected average of 2 weeks

Long-term cognitive impairment composite

Clinical data will be obtained from the medical record to determine a composite measure of long-term cognitive impairment. The composite will include specific outcomes, and follow-up phone interviews with be conducted with a parent/legal guardian at 12 months post-hospital discharge of enrolled patients to assess cognitive function using a validated questionnaire that is compared to expected developmental trajectories based on age adjusted norms.

Time frame: 1 year