Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units

Intensive Care Med. 2009 Nov;35(11):1843-9. doi: 10.1007/s00134-009-1652-8.


Context: If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required.

Objective: Relating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm.

Results: Delirium-inducing factors, disturbance of consciousness and inattention are common in PICU patients: a pre-delirious state is present in most. An algorithm is introduced, containing (1) evaluation of the sedation-agitation level, (2) psychometric assessment of behavior and (3) opinion of the caregivers.

Discussion: It may be argued that the behavioral focus of the algorithm would benefit from the inclusion of neurocognitive measures.

Limitations: No sufficiently validated diagnostic instrument covering the entire algorithm is available yet.

Conclusion: This is the first proposal for a PD diagnostic algorithm. Given the high prevalence of predelirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.

Publication types

  • Review

MeSH terms

  • Age Factors
  • Algorithms*
  • Child
  • Child, Preschool
  • Consciousness Disorders / diagnosis
  • Consciousness Disorders / etiology
  • Critical Care / methods*
  • Decision Trees
  • Delirium / diagnosis*
  • Delirium / epidemiology
  • Delirium / etiology
  • Delirium / therapy
  • Diagnosis, Differential
  • Diagnostic and Statistical Manual of Mental Disorders
  • Early Diagnosis
  • Humans
  • Intensive Care Units, Pediatric
  • Pain Measurement
  • Pediatrics / methods
  • Psychiatric Status Rating Scales
  • Psychometrics
  • Risk Assessment / methods
  • Risk Factors
  • Severity of Illness Index
  • Vital Signs