Delirium Detection in Pediatric Intensive Care Unit Through a French Translation of the CAPD : a French Monocentric Observational Study

Assistance Publique - Hôpitaux de Paris

Overview

The purpose of this study is to introduce delirium detection and try to determine the prevalence of delirium in Pediatric Intensive Care Unit (PICU) using a validated tool : the Cornell Assessment of Pediatric Delirium (CAPD) for every patient twice a day.

Delirium is a frequent affection in ICU. In adult population, its prevalence is 20-50% in non intubated patients and 60-80% in patients under invasive ventilation. It is also frequent in paediatric population, but less diagnosed, whereas it can lead to higher duration stay, higher morbidity, traumatic injuries, acute stress, memory losses and post-traumatic stress syndrome. Since 2016, international guidelines recommend to look for delirium in paediatric population in PICU. There are 3 recommended tools to diagnose this affection: psCAM-ICU (6 months-5 years old), pCAM-ICU (5 years old-18 years old) and CAPD (birth-18 years old). None of these validated tools have been translated in French. The principal objective is to study the practicability of twice a day detection of delirium in PICU using the CAPD. Investigators will first used a validation process to translate the CAPD in French, based on the validation method for psychological questionnaires suggested by Vallerand. Then they will ask the paramedics to evaluate through the CAPD every consecutive patient/12 hours, every day during their stay in PICU, except for those completely unresponsive or under curare. This systematic evaluation will take place for 2 consecutive months. For every patient, data will be collected about their age, sexe, term of birth, mental affection status, diagnosis at entry, and daily risk of mortality score, length of stay, ventilation, pain evaluation and treatment, withdrawal evaluation, surroundings, use of hypnotic treatment, steroids, opioids and ketamine. The secondary aims are to determine the prevalence of delirium with the data collected, to ask whether or not the French version of CAPD has been easily and correctly used, can help to diagnose delirium, and whether investigators can find some associated parameters to delirium.

Study Type

OBSERVATIONAL

Conditions

Delirium

Interventions

CAPDDIAGNOSTIC_TEST

CAPD evaluation every day per 12hours during their stay in PICU

Eligibility

Sex: ALLMax age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Being hospitalized in PICU during the inclusion period * Age 0 to 18 years old Exclusion Criteria: * Patient with a state of sedation that does not allow the assessment of a change in the state of consciousness or cognitive functioning (equivalent score Richmond Agitation-Sedation Scale RASS \<-3 or COMFORT B \<11) * Patient or Parental opposition to the observational study

Locations (1)

Necker Enfants Malades Hospital

Paris, France

Outcomes

Primary Outcomes

Prevalence of delirium in the PICU population

Number of CAPD evaluated \> 9 / total number of CAPD evaluated

Time frame: 2 months

Secondary Outcomes

Applicability of the CAPD by the paramedics

5 questions : 1. Whether or not they have already heard about delirium 2. Whether or not they know the symptoms of delirium in children and adolescents 3. Whether or not they have already been confronted to a state of delirium in the Pediatric Intensive Care Unit 4. Whether of not they think it would be useful to have a specific scale to diagnose delirium in the Pediatric Intensive Care Unit 5. Whether or not they think it would be feasible to use such a scale regularly in the Pediatric Intensive Care Unit The proposed answers will be Yes, No or I don't know for each question The analysis will be qualitative and quantitative.

Time frame: Before inclusion period

Applicability of the CAPD by the paramedics after the 2 months period

The same 5 questions of the pre-test, 5 new closed-ended questions and 3 open-ended questions : 1. Whether or not they had difficulties evaluating patients with the CAPD 2. How they evaluate the duration of the evaluation by the CAPD 3. Whether or not they evaluated the patients with a colleague 4. Whether or not they think that the assessment of delirium by the CAPD is relevant among PICU patients 5. Whether or not they think that a long-term evaluation of delirium by the CAPD is feasible in this PICU unit 1- If difficulties of evaluating patients with the CAPD : quote the difficulties 2- In which categories of patients do they think that the CAPD in not adapted 3- Comment or suggestions to improve the use of the scale

Time frame: 2 months

Use of the CAPD by the paramedics

% of CAPD completed during the 2 months period

Time frame: 2 months

Age

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.