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Delirium

Pathway Background and Objectives

Delirium is defined as an acute-onset neuropsychiatric syndrome characterized by disturbances of cognition, attention, consciousness or perception that is potentially life threatening. It is important to recognize that delirium is secondary to a medical etiology, not an isolated psychiatric condition (Schieveld 2014, DSM5).  Delirium can occur because of underlying illness, hospitalization, medications or trauma (Cerejeira 2012). Delirium is a high-risk diagnosis, and is a sign of acute brain dysfunction and a marker for potential significant clinical decompensation (Maldonado 2017). The signs of delirium can be very subtle and it is often under recognized in children. However, all hospitalized patients are at risk for developing delirium. It effects an estimated 10-44% of hospitalized children and up to 30% of PICU patients (Traube 2014, Traube 2017, Smith 2013). Treatment requires inter-professional collaboration between primary physicians, specialists, nursing and family (Bettencourt 2017). Early recognition and treatment may prevent adverse outcomes.

The objectives of this pathway are to:

  • Establish interventions to help prevent delirium in all hospitalized patients
  • Provide a process for delirium assessment and screening using a validated screening method, Cornell Assessment of Pediatric Delirium (CAPD)
  • Provide guidance and recommendations for appropriate medical evaluation and management for patients with recognized delirium

Algorithm

Quality Metrics

  • Percentage of patients on medical surgical units who were not screened with the CAPD
  • Percent of patients who were screened with CAPD tool twice daily
  • Percent of patients with CAPD score ≥ 9 with delirium pathway order set usage
  • Average time from CAPD score ≥ 9 to the initiation of the delirium pathway order set
  • Number of PICU transfers following CAPD score ≥ 9
  • Number of MET activations following CAPD score ≥ 9
  • Percent of patients with CAPD score ≥ 9 who have delirium ICD-10 codes applied
  • Percent of patients with CAPD score ≥ 9 who have a psychiatry evaluation
  • Percent of patients with CAPD score ≥ 9 who have a CT scan
  • ALOS for patients with a CAPD score ≥ 9 (days)

Educational Module

Download Delirium Educational Module

Key References

Pathway Contacts

Emilee Lewis, MD
Lisa Namerow, MD

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.

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