Cornell Assessment of Pediatric Delirium (CAPD)
Screens for pediatric delirium.
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.
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.
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Reorientation with familiar toys, games, and routines is helpful in managing delirium.
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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.
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Pediatric delirium that threatens the safety of the patient, family, or staff, or delirium refractory to behavioral and environmental interventions, may require pharmacologic treatment.
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Avoidance of early morning blood draws and other testing, which can disrupt normal sleep patterns, can help reduce the risk or severity of delirium.
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Monitor especially closely for delirium in developmentally delayed children, who are at higher risk than non-delayed children.
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A positive CAPD screen for delirium should prompt additional intervention and investigation. Consultation with child life specialists or child psychiatry may be beneficial.