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Pediatric delirium: Evaluating the gold standard

Published online by Cambridge University Press:  24 April 2014

Gabrielle Silver ,
Julia Kearney ,
Chani Traube ,
Thomas M. Atkinson ,
Katarzyna E. Wyka  and
John Walkup
Gabrielle Silver*
Affiliation:
Weill Cornell Medical College, New York, New York
Julia Kearney
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York, New York
Chani Traube
Affiliation:
Weill Cornell Medical College, New York, New York
Thomas M. Atkinson
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York, New York
Katarzyna E. Wyka
Affiliation:
Weill Cornell Medical College, New York, New York City University of New York, New York, New York
John Walkup
Affiliation:
Weill Cornell Medical College, New York, New York
*
Address correspondence and reprint requests to: Gabrielle Silver, Consultation Liaison Child Psychiatry, Weill Cornell Medical College/New York Presbyterian Hospital, 525 East 68th Street, Box 140, New York, New York 10065. E-mail: [email protected]
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Abstract

Objective:

Our aim was to evaluate interrater reliability for the diagnosis of pediatric delirium by child psychiatrists.

Method:

Critically ill patients (N = 17), 0–21 years old, including 7 infants, 5 children with developmental delay, and 7 intubated children, were assessed for delirium using the Diagnostic and Statistical Manual–IV (DSM–IV) (comparable to DSM–V) criteria. Delirium assessments were completed by two psychiatrists, each blinded to the other's diagnosis, and interrater reliability was measured using Cohen's κ coefficient along with its 95% confidence interval.

Results:

Interrater reliability for the psychiatric assessment was high (Cohen's κ = 0.94, CI [0.83, 1.00]). Delirium diagnosis showed excellent interrater reliability regardless of age, developmental delay, or intubation status (Cohen's κ range 0.81–1.00).

Significance of results:

In our study cohort, the psychiatric interview and exam, long considered the “gold standard” in the diagnosis of delirium, was highly reliable, even in extremely young, critically ill, and developmentally delayed children. A developmental approach to diagnosing delirium in this challenging population is recommended.

Keywords

DeliriumChild psychiatryPediatric critical care
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 3 , June 2015 , pp. 513 - 516
Copyright
Copyright © Cambridge University Press 2014 

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