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    Cornell Assessment of Pediatric Delirium (CAPD)

    Screens for pediatric delirium.
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    INSTRUCTIONS

    Do not use in patients with Richmond Agitation-Sedation Scale (RASS) ≤-4 (deep sedation: no response to voice, but movement or eye opening to physical stimulation, or unarousable: no response to voice or physical stimulation). Includes developmental anchor points for children at 8 weeks and 1 year to improve screening accuracy in very young patients.

    When to Use
    Pearls/Pitfalls
    Why Use
    • In critically ill pediatric patients aged 0-21 years.

    • May be used in both developmentally normal and delayed patients.

    • Pediatric delirium often presents differently than that of adults. Children may be more likely to have a catatonia-like presentation, with general listlessness and paucity of speech.

    • Children with developmental delay are at higher risk of developing delirium than non-delayed children, and therefore should be monitored more closely for delirium symptoms.

    • As in adults, hospitalized children, particularly those in the PICU, are at high risk of developing delirium.

    • In turn, delirium in children is associated with complications such as increased length of stay, post-traumatic stress symptoms, and possible long-term neurodevelopmental issues.

    Newborn
    4 weeks
    6 weeks
    8 weeks
    28 weeks
    1 year
    2 years

    Result:

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    Next Steps
    Evidence
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    Advice

    While all children in the PICU should receive behavioral interventions to prevent potential delirium, making the diagnosis of delirium is often difficult in children. This score can assist the clinician in screening for delirium.

    Management

    • Reorientation with familiar toys, games, and routines is helpful in managing delirium.

    • Maintenance of normal day/night cycle-based lighting in ICU rooms can be difficult but helpful in the prevention and management of delirium for both children and adults.

    • Pediatric delirium that threatens the safety of the patient, family, or staff, or delirium refractory to behavioral and environmental interventions, may require pharmacologic treatment.

    • Avoidance of early morning blood draws and other testing, which can disrupt normal sleep patterns, can help reduce the risk or severity of delirium.

    Critical Actions

    • Monitor especially closely for delirium in developmentally delayed children, who are at higher risk than non-delayed children.

    • A positive CAPD screen for delirium should prompt additional intervention and investigation. Consultation with child life specialists or child psychiatry may be beneficial.

    Content Contributors
    Reviewed By
    • Mohamed Gaffoor, MD
    About the Creator
    Dr. Chani Traube
    Dr. Gabrielle Silver
    Are you Dr. Gabrielle Silver?
    Content Contributors
    Reviewed By
    • Mohamed Gaffoor, MD