• Jan N M Schieveld, Judith A van der Valk, Inge Smeets, Eline Berghmans, Renske Wassenberg, Piet L M N Leroy, Gijs D Vos, and Jim van Os.
• Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, European Graduate School of Neuroscience, SEARCH, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands. jan.schieveld@mumc.nl
• Intensive Care Med. 2009 Nov 1; 35 (11): 184318491843-9.

ContextIf delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required.ObjectiveRelating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm.ResultsDelirium-inducing factors, disturbance of consciousness and inattention are common in PICU patients: a pre-delirious state is present in most. An algorithm is introduced, containing (1) evaluation of the sedation-agitation level, (2) psychometric assessment of behavior and (3) opinion of the caregivers.DiscussionIt may be argued that the behavioral focus of the algorithm would benefit from the inclusion of neurocognitive measures.LimitationsNo sufficiently validated diagnostic instrument covering the entire algorithm is available yet.ConclusionThis is the first proposal for a PD diagnostic algorithm. Given the high prevalence of predelirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.

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