Diagnose Pediatric Delirium Preferentially by Psychiatric Examination, as CAPD Has Low Specificity
Year: 2025
Type: article
Abstract: We read with interest the article by Nashit et al. on a cross-sectional study of the prevalence and risk factors of delirium, which was diagnosed using the Cornell assessment of pediatric delirium (CAPD) in 201 patients aged 1 month-14 years admitted to a pediatric intensive care unit (PICU) in Karachi. 1 The frequency of delirium in the cohort studied was 25%, and the risk factors for the occurrence of delirium were comorbidities, developmental delays, medications (e.g., benzodiazepines, antiepileptics), high-flow oxygen, and mechanical ventilation. 1 The study is interesting, but some points need to be discussed.The first point is that delirium was diagnosed using CAPD, not psychiatric examinations.Cornell assessment of pediatric delirium has several disadvantages.Its results are based on observations, and performing the test does not require interaction with the patient.Repeated test results can vary greatly, and performing the test is time-consuming.In addition, the specificity of the test is low, ranging from 45 to 79% with a cutoff value of 9. 2 Delirium should be diagnosed through a comprehensive psychiatric examination based on criteria from the diagnostic and statistical manual of mental (DSM), such as the confusion assessment method (CAM), which is considered the gold standard for diagnosing delirium.3 The CAM is a structured tool derived from these criteria and is considered the most widely used and effective tool for diagnosing delirium at the bedside.The second point is that the causes of delirium in the cohort studied were not specified in detail. 1 Causes of delirium include not only medications, but also infections (e.g., urinary tract infections, pneumonia), endocrine disorders (e.g., diabetes, thyroid dysfunction), pain, surgery, sleep deprivation, electrolyte imbalances, dehydration, intoxication, and substance withdrawal.4 Knowledge of the underlying cause of delirium is crucial for optimal treatment of the condition.The third point is that differential diagnoses of delirium have not been sufficiently ruled out. 1 Differential diagnoses of delirium include psychosis, dementia, depression, systemic infections, metabolic disorders, systemic diseases, and many neurological diseases.In order to rule out all of these conditions, not only psychiatric examinations but also comprehensive clinical and instrumental examinations must be performed.The instrumental examinations required for the diagnosis of delirium include comprehensive blood tests, cerebral imaging using magnetic resonance imaging, magnetic resonance angiography, electroencephalography, and, if necessary, cerebrospinal fluid examinations, magnetic resonance spectroscopy, and positron emission tomography.
Institutions: Universidade Federal de São Paulo, University of Vienna
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7116791814