Main Article Content
Abstract
INTRODUZIONE: Il delirium pediatrico è associato ad una maggior durata di degenza all'interno delle terapie intensive pediatriche ed alla comparsa di sintomi post-traumatici. Nei bambini molto piccoli, in etí prescolare, la diagnosi del delirium appare piuttosto impegnativa. Recentemente è stato sviluppato ed individuato anche dalla letteratura internazionale uno strumento di screening del delirium pediatrico adatto ai bambini critici ricoverati in etí prescolare, con ottimi risultati anche nei neonati critici al di sotto dei 2 anni di etí : la Cornell Assessment of Pediatric Delirium (CAPD). La CAPD fonda la valutazione del delirium pediatrico nel contesto dello sviluppo del bambino. Tale scala segue lo sviluppo del neonato rapportando la rilevazione degli item specifici della scala a punti di ancoraggio che caratterizzano lo sviluppo dei piccoli pazienti suddivisi per fasce di etí .
OBIETTIVO: eseguire una validazione linguistico culturale in lingua Italiana e test preliminari della Cornell Assessment of Pediatric Delirium per la valutazione/diagnosi del delirium pediatrico all'interno delle terapie intensive pediatriche.
METODO: Studio di traduzione e validazione culturale. La traduzione e l'adattamento culturale di tale strumento ha seguito le fasi del modello proposto dalla World Health Organization. Test preliminari, come item descriptive analysis, item-total correlation e alfa di Cronbach, sono stati effettuati.
RISULTATI: Tutte le fasi del processo di validazione linguistico culturale sono state realizzate in modo soddisfacente. Per le analisi preliminari, la scala è stata somministrata ad un campione di 42 bambini, con etí compresa da 0-5 anni (66.6%), con una maggiore prevalenza del sesso maschile. I test preliminari hanno mostrato una buona distribuzione di tutti gli item. Tutti i coefficienti dell'Item-total correlation avevano valori superiori rispetto il valore raccomandato di 0.30. Inoltre l'alfa di Cronbach ha mostrato valori superiori allo 0.90.
CONCLUSIONI: Il processo ha minuziosamente seguito le raccomandazioni presenti nella letteratura internazionale. La versione finale è stata approvata dagli autori dello strumento originale.
Parole chiave: delirium pediatrico, CAPD, validazione italiana
ABSTRACT -
Cornell Assessment of Pediatric Delirium: Italian cultural validation and preliminary testing
INTRODUCTION: Paediatric delirium is associated with a longer duration of hospitalization in paediatric intensive care units, the emergence of post-traumatic symptoms and possible neurocognitive dysfunction after discharge. In preschool children, the diagnosis of delirium appears rather challenging: their pre-verbal status and the presence of cognitive skills still in development make accurate diagnosis difficult. Recently, a pediatric delirium screening tool suitable for critical preschool children has also been developed and identified in international literature, with excellent results also in critical infants under 2 years of age: the Cornell Assessment of Pediatric Delirium (CAPD). The CAPD, using a Likert scale, bases the assessment of paediatric delirium within the context of child development. This scale follows the development of the infant by comparing the detection of specific items on the scale as the anchor points that characterize the development of infants by age groups.
OBJECTIVE: Culturally and linguistically validation in Italian language and prior testing of the Cornell Assessment of Pediatric Delirium.
METHOD: Translation and Cultural Validation of the Cornell Assessment of Pediatric Delirium (CAPD) for the Evaluation/Diagnosis of Pediatric Delirium within Pediatric Intensive Care. The translation and adaptation of this instrument followed the phases of the model proposed by the World Health Organization. Prior testings, such as item descriptive analysis, item-total correlation and Cronbach's alpha, were conducted.
RESULTS: All phases of the cultural-linguistic validation process were carried out in a satisfactory manner. For the prior testing, the scale was administered to a sample of 42 children, with age ranged 0-5 years old (66.6%), with a higher prevalence of the male gender. All items were normally distributed and there was no excessive Skeweness and Kurtosis. Each item contributed to the scale fairly well and all coefficients of item total correlation (rjx) were higher than the recommended level of 0.30. The composite reliability index was 0.94 and Cronbach's alpha was 0.96.
CONCLUSIONS: The process has meticulously followed the recommendations in international literature. The final version was approved by the authors of the original instrument. Key words: pediatric delirium, CAPD, Italian validation riassunto
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References
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- Allen, J., & Alexander, E. (2012). Prevention, recognition, and management of delirium in the intensive care unit. AACN Adv Crit Care, 23(1), 5-11; quiz 12-13. doi: 10.1097/NCI.0b013e31822c3633
- Balas, M. C., Rice, M., Chaperon, C., Smith, H., Disbot, M., & Fuchs, B. (2012). Management of delirium in critically ill older adults. Crit Care Nurse, 32(4), 15-26. doi: 10.4037/ccn2012480
- Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gelinas, C., Dasta, J. F., . . . Jaeschke, R. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 41(1), 263-306. doi: 10.1097/CCM.0b013e3182783b72
- Blankespoor, R. J., Janssen, N. J., Wolters, A. M., Van Os, J., & Schieveld, J. N. (2012). Post-hoc revision of the pediatric anesthesia emergence delirium rating scale: clinical improvement of a bedside-tool? Minerva Anestesiol, 78(8), 896-900.
- Brahmbhatt, K., & Whitgob, E. (2016). Diagnosis and Management of Delirium in Critically Ill Infants: Case Report and Review. Pediatrics, 137(3), e20151940. doi: 10.1542/peds.2015-1940
- Colville, G., Kerry, S., & Pierce, C. (2008). Children's factual and delusional memories of intensive care. Am J Respir Crit Care Med, 177(9), 976-982. doi: 10.1164/rccm.200706-857OC
- Daoud, A., Duff, J. P., Joffe, A. R., & Alberta Sepsis, Network. (2014). Diagnostic accuracy of delirium diagnosis in pediatric intensive care: a systematic review. Crit Care, 18(5), 489. doi: 10.1186/s13054-014-0489-x
- Diamond, I. R., Grant, R. C., Feldman, B. M., Pencharz, P. B., Ling, S. C., Moore, A. M., & Wales, P. W. (2014). Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol, 67(4), 401-409. doi: 10.1016/j.jclinepi.2013.12.002
- Ely, E. W., Shintani, A., Truman, B., Speroff, T., Gordon, S. M., Harrell, F. E., Jr., . . . Dittus, R. S. (2004). Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Jama, 291(14), 1753-1762. doi: 10.1001/jama.291.14.1753
- Epstein, J., Santo, R. M., & Guillemin, F. (2015). A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a consensus. J Clin Epidemiol, 68(4), 435-441. doi: 10.1016/j.jclinepi.2014.11.021
- Hatherill, S., Flisher, A. J., & Nassen, R. (2010). Delirium among children and adolescents in an urban sub-Saharan African setting. J Psychosom Res, 69(2), 187-192. doi: 10.1016/j.jpsychores.2010.01.011
- Inouye, S. K. (2006). Delirium in older persons. N Engl J Med, 354(11), 1157-1165. doi: 10.1056/NEJMra052321
- Jakob, S. M., Ruokonen, E., Grounds, R. M., Sarapohja, T., Garratt, C., Pocock, S. J., . . . Takala, J. (2012). Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. Jama, 307(11), 1151-1160. doi: 10.1001/jama.2012.304
- Janssen, N. J., Tan, E. Y., Staal, M., Janssen, E. P., Leroy, P. L., Lousberg, R., . . . Schieveld, J. N. (2011). On the utility of diagnostic instruments for pediatric delirium in critical illness: an evaluation of the Pediatric Anesthesia Emergence Delirium Scale, the Delirium Rating Scale 88, and the Delirium Rating Scale-Revised R-98. Intensive Care Med, 37(8), 1331-1337. doi: 10.1007/s00134-011-2244-y
- Leentjens, A. F., Schieveld, J. N., Leonard, M., Lousberg, R., Verhey, F. R., & Meagher, D. J. (2008). A comparison of the phenomenology of pediatric, adult, and geriatric delirium. J Psychosom Res, 64(2), 219-223. doi: 10.1016 /j.jpsychores.2007.11.003
- Madden, K., Turkel, S., Jacobson, J., Epstein, D., & Moromisato, D. Y. (2011). Recurrent delirium after surgery for congenital heart disease in an infant. Pediatr Crit Care Med, 12(6), e413-415. doi: 10.1097/PCC.0b013e31820ac2bf
- Martini, D. R. (2005). Commentary: the diagnosis of delirium in pediatric patients. J Am Acad Child Adolesc Psychiatry, 44(4), 395-398. doi: 10.1097/01.chi.0000153716.52154.cf
- Neto, A. S., Nassar, A. P., Jr., Cardoso, S. O., Manetta, J. A., Pereira, V. G., Esposito, D. C., . . . Slooter, A. J. (2012).
- 1176/appi.ajp.2010.09111606
- Silver, G., Kearney, J., Traube, C., & Hertzig, M. (2015). Delirium screening anchored in child development: The Cornell Assessment for Pediatric Delirium. Palliat Support Care, 13(4), 1005-1011. doi: 10.1017/S1478951514000947
- Silver, G., Traube, C., Gerber, L. M., Sun, X., Kearney, J., Patel, A., & Greenwald, B. (2015). Pediatric delirium and associated risk factors: a single-center prospective observational study. Pediatr Crit Care Med, 16(4), 303-309. doi: 10.1097/PCC.0000000000000356
- Silver, G., Traube, C., Kearney, J., Kelly, D., Yoon, M. J., Nash Moyal, W., . . . Ward, M. J. (2012). Detecting pediatric delirium: development of a rapid observational assessment tool. Intensive Care Med, 38(6), 1025-1031. doi: 10.1007/s00134-012-2518-z
- Simeone, S., Pucciarelli, G., Perrone, M., Rea, T., Gargiulo, G., Dell'Angelo, G., . . . Vosa, C. (2017). Comparative Analysis: Implementation of a Pre-operative Educational Intervention to Decrease Anxiety Among Parents of Children With Congenital Heart Disease. J Pediatr Nurs, 35, 144-148. doi: 10.1016/j.pedn.2017.01.008
- Smeets, I. A., Tan, E. Y., Vossen, H. G., Leroy, P. L., Lousberg, R. H., van Os, J., & Schieveld, J. N. (2010). Prolonged stay at the paediatric intensive care unit associated with paediatric delirium. Eur Child Adolesc Psychiatry, 19(4), 389-393. doi: 10.1007/s00787-009-0063-2
- Spronk, P. E., Riekerk, B., Hofhuis, J., & Rommes, J. H. (2009). Occurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Med, 35(7), 1276-1280. doi: 10.1007/s00134-009-1466-8
- Traube, C., Silver, G., Kearney, J., Patel, A., Atkinson, T. M., Yoon, M. J., . . . Greenwald, B. (2014). Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU*. Crit Care Med, 42(3), 656-663. doi: 10.1097/CCM.0b013e3182a66b76
- Turkel, S. B., Braslow, K., Tavare, C. J., & Trzepacz, P. T. (2003). The delirium rating scale in children and adolescents. Psychosomatics, 44(2), 126-129.
References
Adamis, D., Treloar, A., Martin, F. C., & Macdonald, A. J. (2006). Recovery and outcome of delirium in elderly medical inpatients. Arch Gerontol Geriatr, 43(2), 289-298. doi: 10.1016/j.archger.2005.11.005
Allen, J., & Alexander, E. (2012). Prevention, recognition, and management of delirium in the intensive care unit. AACN Adv Crit Care, 23(1), 5-11; quiz 12-13. doi: 10.1097/NCI.0b013e31822c3633
Balas, M. C., Rice, M., Chaperon, C., Smith, H., Disbot, M., & Fuchs, B. (2012). Management of delirium in critically ill older adults. Crit Care Nurse, 32(4), 15-26. doi: 10.4037/ccn2012480
Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gelinas, C., Dasta, J. F., . . . Jaeschke, R. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 41(1), 263-306. doi: 10.1097/CCM.0b013e3182783b72
Blankespoor, R. J., Janssen, N. J., Wolters, A. M., Van Os, J., & Schieveld, J. N. (2012). Post-hoc revision of the pediatric anesthesia emergence delirium rating scale: clinical improvement of a bedside-tool? Minerva Anestesiol, 78(8), 896-900.
Brahmbhatt, K., & Whitgob, E. (2016). Diagnosis and Management of Delirium in Critically Ill Infants: Case Report and Review. Pediatrics, 137(3), e20151940. doi: 10.1542/peds.2015-1940
Colville, G., Kerry, S., & Pierce, C. (2008). Children's factual and delusional memories of intensive care. Am J Respir Crit Care Med, 177(9), 976-982. doi: 10.1164/rccm.200706-857OC
Daoud, A., Duff, J. P., Joffe, A. R., & Alberta Sepsis, Network. (2014). Diagnostic accuracy of delirium diagnosis in pediatric intensive care: a systematic review. Crit Care, 18(5), 489. doi: 10.1186/s13054-014-0489-x
Diamond, I. R., Grant, R. C., Feldman, B. M., Pencharz, P. B., Ling, S. C., Moore, A. M., & Wales, P. W. (2014). Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol, 67(4), 401-409. doi: 10.1016/j.jclinepi.2013.12.002
Ely, E. W., Shintani, A., Truman, B., Speroff, T., Gordon, S. M., Harrell, F. E., Jr., . . . Dittus, R. S. (2004). Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Jama, 291(14), 1753-1762. doi: 10.1001/jama.291.14.1753
Epstein, J., Santo, R. M., & Guillemin, F. (2015). A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a consensus. J Clin Epidemiol, 68(4), 435-441. doi: 10.1016/j.jclinepi.2014.11.021
Hatherill, S., Flisher, A. J., & Nassen, R. (2010). Delirium among children and adolescents in an urban sub-Saharan African setting. J Psychosom Res, 69(2), 187-192. doi: 10.1016/j.jpsychores.2010.01.011
Inouye, S. K. (2006). Delirium in older persons. N Engl J Med, 354(11), 1157-1165. doi: 10.1056/NEJMra052321
Jakob, S. M., Ruokonen, E., Grounds, R. M., Sarapohja, T., Garratt, C., Pocock, S. J., . . . Takala, J. (2012). Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. Jama, 307(11), 1151-1160. doi: 10.1001/jama.2012.304
Janssen, N. J., Tan, E. Y., Staal, M., Janssen, E. P., Leroy, P. L., Lousberg, R., . . . Schieveld, J. N. (2011). On the utility of diagnostic instruments for pediatric delirium in critical illness: an evaluation of the Pediatric Anesthesia Emergence Delirium Scale, the Delirium Rating Scale 88, and the Delirium Rating Scale-Revised R-98. Intensive Care Med, 37(8), 1331-1337. doi: 10.1007/s00134-011-2244-y
Leentjens, A. F., Schieveld, J. N., Leonard, M., Lousberg, R., Verhey, F. R., & Meagher, D. J. (2008). A comparison of the phenomenology of pediatric, adult, and geriatric delirium. J Psychosom Res, 64(2), 219-223. doi: 10.1016 /j.jpsychores.2007.11.003
Madden, K., Turkel, S., Jacobson, J., Epstein, D., & Moromisato, D. Y. (2011). Recurrent delirium after surgery for congenital heart disease in an infant. Pediatr Crit Care Med, 12(6), e413-415. doi: 10.1097/PCC.0b013e31820ac2bf
Martini, D. R. (2005). Commentary: the diagnosis of delirium in pediatric patients. J Am Acad Child Adolesc Psychiatry, 44(4), 395-398. doi: 10.1097/01.chi.0000153716.52154.cf
Neto, A. S., Nassar, A. P., Jr., Cardoso, S. O., Manetta, J. A., Pereira, V. G., Esposito, D. C., . . . Slooter, A. J. (2012).
1176/appi.ajp.2010.09111606
Silver, G., Kearney, J., Traube, C., & Hertzig, M. (2015). Delirium screening anchored in child development: The Cornell Assessment for Pediatric Delirium. Palliat Support Care, 13(4), 1005-1011. doi: 10.1017/S1478951514000947
Silver, G., Traube, C., Gerber, L. M., Sun, X., Kearney, J., Patel, A., & Greenwald, B. (2015). Pediatric delirium and associated risk factors: a single-center prospective observational study. Pediatr Crit Care Med, 16(4), 303-309. doi: 10.1097/PCC.0000000000000356
Silver, G., Traube, C., Kearney, J., Kelly, D., Yoon, M. J., Nash Moyal, W., . . . Ward, M. J. (2012). Detecting pediatric delirium: development of a rapid observational assessment tool. Intensive Care Med, 38(6), 1025-1031. doi: 10.1007/s00134-012-2518-z
Simeone, S., Pucciarelli, G., Perrone, M., Rea, T., Gargiulo, G., Dell'Angelo, G., . . . Vosa, C. (2017). Comparative Analysis: Implementation of a Pre-operative Educational Intervention to Decrease Anxiety Among Parents of Children With Congenital Heart Disease. J Pediatr Nurs, 35, 144-148. doi: 10.1016/j.pedn.2017.01.008
Smeets, I. A., Tan, E. Y., Vossen, H. G., Leroy, P. L., Lousberg, R. H., van Os, J., & Schieveld, J. N. (2010). Prolonged stay at the paediatric intensive care unit associated with paediatric delirium. Eur Child Adolesc Psychiatry, 19(4), 389-393. doi: 10.1007/s00787-009-0063-2
Spronk, P. E., Riekerk, B., Hofhuis, J., & Rommes, J. H. (2009). Occurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Med, 35(7), 1276-1280. doi: 10.1007/s00134-009-1466-8
Traube, C., Silver, G., Kearney, J., Patel, A., Atkinson, T. M., Yoon, M. J., . . . Greenwald, B. (2014). Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU*. Crit Care Med, 42(3), 656-663. doi: 10.1097/CCM.0b013e3182a66b76
Turkel, S. B., Braslow, K., Tavare, C. J., & Trzepacz, P. T. (2003). The delirium rating scale in children and adolescents. Psychosomatics, 44(2), 126-129.