Sophia Observation withdrawal Symptoms-Paediatric Delirium scale: A tool for early screening of delirium in the PICU

Aust Crit Care. 2018 Sep;31(5):266-273. doi: 10.1016/j.aucc.2017.07.006. Epub 2017 Aug 24.

Abstract

Background: Delirium in critically ill children is a severe neuropsychiatric disorder which has gained increased attention from clinicians. Early identification of delirium is essential for successful management. The Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale was developed to detect Paediatric Delirium (PD) at an early stage.

Objective: The aim of this study was to determine the measurement properties of the PD component of the SOS-PD scale in critically ill children.

Methods: A prospective, observational study was performed in patients aged 3 months or older and admitted for more than 48h. These patients were assessed with the SOS-PD scale three times a day. If the SOS-PD total score was 4 or higher in two consecutive observations, the child psychiatrist was consulted to assess the diagnosis of PD using the Diagnostic and Statistical Manual-IV criteria as the "gold standard". The child psychiatrist was blinded to outcomes of the SOS-PD. The interrater reliability of the SOS-PD between the care-giving nurse and a researcher was calculated with the intraclass correlation coefficient (ICC).

Results: A total of 2088 assessments were performed in 146 children (median age 49 months; IQR 13-140). The ICC of 16 paired nurse-researcher observations was 0.90 (95% CI 0.70-0.96). We compared 63 diagnoses of the child psychiatrist versus SOS-PD assessments in 14 patients, in 13 of whom the diagnosis of PD was confirmed. The sensitivity was 96.8% (95% CI 80.4-99.5%) and the specificity was 92.0% (95% CI 59.7-98.9%).

Conclusions: The SOS-PD scale shows promising validity for early screening of PD. Further evidence should be obtained from an international multicentre study.

Keywords: Assessment tool; Benzodiazepine; Iatrogenic withdrawal syndrome (IWS); PICU; Paediatric Delirium; Sedation.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Critical Illness*
  • Delirium / diagnosis*
  • Humans
  • Infant
  • Intensive Care Units, Pediatric*
  • Male
  • Mass Screening / methods*
  • Prospective Studies
  • Reproducibility of Results
  • Sensitivity and Specificity