Development of the Vanderbilt Assessment for Delirium in Infants and Children to Standardize Pediatric Delirium Assessment By Psychiatrists

Background Pediatric deliriumassessment is complicated by variations in baseline language and cognitive skills, impairment during illness, and absence of pediatric-specific modifiers within the Diagnostic and Statistical Manual of Mental Disorders deliriumcriterion. Objective To develop a standardized approach to pediatric deliriumassessment by psychiatrists. Methods A multidisciplinary group of clinicians used Diagnostic and Statistical Manual criterion as the foundation for the Vanderbilt Assessment for Deliriumin Infants and Children (VADIC). Pediatric-specific modifiers were integrated into the deliriumcriterion, including key developmental and assessment variations for children. The VADIC was used in clinical practice to prospectively assess critically ill infants and children. The VADIC was assessed for content validityby the American Academy of Childand Adolescent Psychiatry Delirium Special Interest Group. Results The American Academy of Childand Adolescent Psychiatry- Delirium Special Interest Groupdetermined that the VADIC demonstrated high content validity. The VADIC (1) preserved the core Diagnostic and Statistical Manual deliriumcriterion, (2) appropriately paired interactive assessments with key criterion based on development, and (3) addressed confounders for delirium. A cohort of 300 patients with a median age of 20 months was assessed for deliriumusing the VADIC. Deliriumprevalence was 47%. Conclusion The VADIC provides a comprehensive framework to standardize pediatric deliriumassessment by psychiatrists. The need for consistency in both deliriumeducation and diagnosis is highlighted given the high prevalence of pediatric delirium.