Cornell Assessment of Pediatric Delirium (CAPD)

Why did you develop the Cornell Assessment of Pediatric Delirium (CAPD)? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

In my role as a pediatric intensivist, I noted that many of my patients were not acting appropriately for age—some were extremely agitated and others inappropriately docile. From reading the literature, I knew that delirium was a frequent and severe complication of critical illness in adults. However, this was not well described within pediatrics, mostly due to the absence of a feasible bedside screening tool that could be used in children of all ages. In collaboration with Dr. Gabrielle Silver, an expert child psychiatrist, we developed the Cornell Assessment of Pediatric Delirium (CAPD) to fill that void.

What pearls, pitfalls and/or tips do you have for users of the Cornell Assessment of Pediatric Delirium (CAPD)? Do you know of cases when it has been applied, interpreted, or used inappropriately?

Score the CAPD based on your observation of the child over several hours, not as a single-point-in-time screen.

How do I score the CAPD in children with developmental delay?

SCORE IT AS YOU SEE IT! No need to interpret or adjust for baseline (e.g. if the child never makes eye contact, score as “never”). We do not automatically assume that a CAPD score >9 means delirium in a child with developmental delay, but the numerical score is important and something we trend.

How do I score the CAPD in very young children?

A developmental anchor points chart is available for kids under 2 years of age, to use as a reference if you need it, when scoring the individual items (see Evidence section).

Who needs to be screened for delirium?

EVERY PATIENT, EVERY SHIFT, especially on the day of admission, and even on the day of discharge. The only exclusions are children who are unarousable to verbal stimulation as they cannot be assessed.

What recommendations do you have for doctors once they have applied the Cornell Assessment of Pediatric Delirium (CAPD)? Are there any adjustments or updates you would make to the score based on new data or practice changes?

Some keys to success:

1. Implement delirium screening as standard of care in your unit. Every patient, every shift.

2. Get your colleagues educated and onboard. The nurses will not comply with screening if they present delirium scores on rounds and the doctors don’t know what to do with the information.

3. Add the CAPD tool to your electronic medical record as part of the flowsheet. This will make it much easier for the nurses to score and will allow for monitoring of compliance.

4. Monitor compliance intensively for the first few months.

5. EARLY SUCCESS: a few key patients will make this all work. Your team will recognize and address delirium, and the child will get better. Then they will become believers!

How do you use the Cornell Assessment of Pediatric Delirium (CAPD) in your own clinical practice? Can you give an example of a scenario in which you use it?

Every patient, every shift. Our nurses score the CAPD on every child at approximately 6 pm (end of day shift) and approximately 6 am (end of night shift).

Any other research in the pipeline that you’re particularly excited about?

So much work to be done! We are particularly excited about addressing the modifiable factors for delirium. For example: prescribing practices (including benzodiazepines and anticholinergics) and sleep disruption. We are also very interested in the long-term effects of delirium on children's cognition and psychological health.

Chani Traube, MD, is an assistant professor of pediatrics in the department of critical care medicine at Weill Cornell Medical College. She is also a pediatrician at New York-Presbyterian Hospital. Dr. Traube’s primary research is focused on pediatric respiratory failure, shock, and delirium.

Gabrielle Silver, MD, is a practicing child and adolescent psychiatrist at New York Presbyterian Hospital. She is also a clinical associate professor of psychiatry at the Weill Cornell Medical College. Dr. Silver’s primary research is focused on screening critically ill children for delirium.