Cornell Assessment of Pediatric Delirium (CAPD)

CAPD Calculator

1. Makes eye contact with caregiver

2. Actions are purposeful

3. Aware of surroundings

4. Communicates needs and wants

5. Restless

6. Inconsolable

7. Underactive / very quiet

8. Takes a long time to respond to interactions

CAPD Score: –

Score: 16

Items 1-4 are reverse scored; default 0 (Never) for all unset items.

Screens for pediatric delirium.

Why Use

As in adults, hospitalized children, particularly those in the PICU, are at high risk of developing delirium. In turn, delirium in children is associated with complications such as increased length of stay, post-traumatic stress symptoms, and possible long-term neurodevelopmental issues.

When to Use

In critically ill pediatric patients aged 0-21 years. May be used in both developmentally normal and delayed patients.

Formula

Addition of the selected points, based on interactions with the patient over the course of one nursing shift. Note that the "best" scores (i.e., associated with absence of delirium) are listed first, e.g. Makes eye contact - always (0 points), Inconsolable - never (0 points). Criteria Points Makes eye contact with caregiver Always 0 Often 1 Sometimes 2 Rarely 3 Never 4 Actions are purposeful Always 0 Often 1 Sometimes 2 Rarely 3 Never 4 Aware of surroundings Always 0 Often 1 Sometimes 2 Rarely 3 Never 4 Communicates needs and wants Always 0 Often 1 Sometimes 2 Rarely 3 Never 4 Restless Never 0 Rarely 1 Sometimes 2 Often 3 Always 4 Inconsolable Never 0 Rarely 1 Sometimes 2 Often 3 Always 4 Underactive (very little movement while awake) Never 0 Rarely 1 Sometimes 2 Often 3 Always 4 Takes long time to respond to interactions Never 0 Rarely 1 Sometimes 2 Often 3 Always 4 Refer to Fig 2 in Silver 2015 for developmental anchor points based on age.

Pearls / Pitfalls

Pediatric delirium often presents differently than that of adults. Children may be more likely to have a catatonia-like presentation, with general listlessness and paucity of speech. Children with developmental delay are at higher risk of developing delirium than non-delayed children, and therefore should be monitored more closely for delirium symptoms.

Management

Reorientation with familiar toys, games, and routines is helpful in managing delirium. Maintenance of normal day/night cycle-based lighting in ICU rooms can be difficult but helpful in the prevention and management of delirium for both children and adults. Pediatric delirium that threatens the safety of the patient, family, or staff, or delirium refractory to behavioral and environmental interventions, may require pharmacologic treatment. Avoidance of early morning blood draws and other testing, which can disrupt normal sleep patterns, can help reduce the risk or severity of delirium.

Critical Actions

Monitor especially closely for delirium in developmentally delayed children, who are at higher risk than non-delayed children. A positive CAPD screen for delirium should prompt additional intervention and investigation. Consultation with child life specialists or child psychiatry may be beneficial.

Advice

While all children in the PICU should receive behavioral interventions to prevent potential delirium, making the diagnosis of delirium is often difficult in children. This score can assist the clinician in screening for delirium.

More Information

Interpretation: CAPD Score Delirium Recommendation ≥9 Present Investigate and treat underlying medical condition(s) causing delirium, consider interventions with parents and child life services, and/or consult to psychiatry or palliative care as appropriate, consider medications like melatonin or QUEtiapine (SEROquel) in select cases <9 Absent Continue usual care and monitoring