Cornell assessment effective for diagnosing delirium in pediatric patients: Study

According to recent research, it has been found out that Cornell assessment of pediatric delirium could be used as an effective instrument in the diagnosis of delirium in pediatric surgical patients, as published in the BMC Pediatrics Journal.

Cornell assessment of pediatric delirium (CAPD) showed an advantage in the diagnosis of pediatric delirium in Chinese critically ill patients. But its performance in surgical patients is still unclear.

Hence, Hong Hong and colleagues from the Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China conducted the present study to validate the diagnostic performance of CAPD in surgical pediatric patients.

The authors carried out a prospective validation study on a total of 170 pediatric patients who underwent selective surgery and general anesthesia. The primary outcome was the incidence of delirium within postoperative three days. CAPD the Chinese version was used to evaluate if the patient had delirium one time per day.

In the meantime, a psychiatrist employed the Diagnostic and Statistical Manual of Mental Disorders fifth edition to diagnose delirium, which was the "gold standard", and the result was considered as the reference standard. Sensitivity, specificity and area under receiver operating characteristic (ROC) curve were calculated to investigate the performance of CAPD.

The following key findings were highlighted-

3. As diagnosed by a psychiatrist, 23 (13.5 %) patients experienced at least one episode of delirium during the follow-up period.
4. When the diagnostic threshold was set at 9, CAPD showed the optimal sensitivity (87.0 %, 95 %CI 65.3 %-96.6 %) and specificity (98.0 %, 95 %CI 93.7 %- 99.5 %) in comparison with other diagnostic thresholds.
5. ROC analysis showed that CAPD was a good delirium assessment instrument with area under curve of 0.911 (95 % CI 0.812 to 1.000, P < 0.001).
6. Agreement between CAPD and reference, the standard was 0.849 (Kappa coefficient, P < 0.001).

Therefore, the authors concluded that "Cornell assessment of pediatric delirium could be used as an effective instrument in the diagnosis of delirium in pediatric surgical patients. When the cutoff point was set at 9, the instrument showed the best diagnostic performance."

The researchers further added that this result provides strong evidence to facilitate delirium assessment in surgical pediatric patients. As a single center cohort study, our result needs to be further verified by multicenter trials.