Background

In the PICU, delirium often goes unrecognised and undertreated and the longer that a child experiences delirium, the more traumatic the consequences. Delirium manifests as a change in the child or infant’s attention and awareness that was not previously there. It develops over a short time and it fluctuates.¹ Knowing when a child has delirium can be challenging because of the variation in age, development and diagnoses. Despite validated tools for screening delirium in children, few PICUs internationally perform screening.² International prevalence studies have reported that at least 30% of critically ill children and adolescents have delirium.^3,4 We do not yet know the prevalence in the UK and Ireland as, until now, screening was rarely performed.

The Paediatric Delirium Group UK & Ireland, established in 2020, is working to address this patient important issue. This group has representation from nearly all PICUs across the UK and Ireland. The majority of PICUs were not screening for delirium and this led to agreement to use a common screening tool – the Cornell Assessment for Paediatric Delirium. The first step in establishing the prevalence of delirium is screening. Once this is known, then we can assess the effectiveness of clinical interventions to prevent or manage delirium.

This Training Manual and additional resources were developed by experts in the field of delirium, educational and implementation from the UK Delirium Group. It was designed to assist CAPD training within PICUs across the UK and Ireland. 

References

1. American Psychiatric Association. American Psychiatric Association DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association; 2013.

2. Kudchadkar SR, Yaster M, Punjabi NM. Sedation, sleep promotion, and delirium screening practices in the care of mechanically ventilated children: A wake-up call for the pediatric critical care community*. Critical Care Medicine. 2014;42(7):1592–1600. doi: 10.1097/CCM.0000000000000326.

3. Silver G, Traube C, Kearney J, Kelly D, Yoon MJ, Nash Moyal W, Ward MJ. Detecting pediatric delirium: Development of a rapid observational assessment tool. Intensive Care Medicine. 2012;38(6):1025–1031. doi: 10.1007/s00134-012-2518-z. [PubMed] [CrossRef] [Google Scholar]