Validity and Reliability of the Brazilian Portuguese Version of the Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU)

Objectives: To determine the validity and reliability of the Brazilian Portuguese Pediatric Confusion Assessment Method for the Intensive Care Unit (BRpCAM-ICU) for diagnosing delirium in patients with chronological and developmental ages from 5 to 17 years in Brazilian Pediatric Intensive Care Units (PICUs).

Methods: Prospective, cross-sectional study performed in eight PICUs, with 116 patients, 5–17 years of age, without developmental delay, submitted to mechanical ventilation or not. To assess the interobserver reliability, two previously trained researchers concomitantly applied the BRpCAM-ICU and independently rated the same patient. To assess the criterion validity, a pediatric neurologist or psychiatrist, blinded to the BRpCAM-ICU assessments, evaluated the same patient within 30 minutes, using the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition – DSM-5, considered the reference standard.

Results: 149 paired assessments were included (some patients had more than one). Delirium was diagnosed in 11 of 149 (7%) assessments, or 8 of 116 (7%) patients, using both the BRpCAM-ICU and the DSM-5. There was one false positive and one false negative diagnosis, which resulted in 90.9% sensitivity (95%CI, 58.7–99.8%) and 99.3% specificity (95%CI, 96–100%) for the BRpCAM-ICU. The interrater reliability was considered almost perfect (κ = 1.0).

Conclusions: The BRpCAM-ICU is a valid and reliable tool for diagnosing delirium in pediatric patients 5–17 years of age in Brazilian PICUs. The implementation of this tool may be useful to reduce underdiagnosis, ensure monitoring and earlier intervention, provide a better prognosis, and improve research on delirium in this age group in Brazil.