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

Abstract

BackgroundDelirium 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. ObjectiveThe aim of this study was to determine the measurement properties of the PD component of the SOS-PD scale in critically ill children. MethodsA 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). ResultsA 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%). ConclusionsThe SOS-PD scale shows promising validity for early screening of PD. Further evidence should be obtained from an international multicentre study.