PICU Delirium Assessment (pCAM-ICU)
Paediatric adaptation of CAM-ICU (Smith 2011) for delirium in critically ill children ≥ 5 years, ventilated or not, who respond to voice (RASS −3 or above). Positive if Features 1 + 2 AND (3 or 4).
Score interpretation
The child does not respond to voice, so delirium cannot be assessed.
→ Reassess when sedation lightens (RASS −3 or above).
Delirium not present.
→ Continue monitoring. Prevent modifiable risk factors (early mobilisation, sleep hygiene, avoid unnecessary benzodiazepines).
Paediatric delirium (Features 1 + 2 and 3 or 4).
→ Non-pharmacological interventions first. Review sedation — minimise benzodiazepines. Treat pain. Maintain sleep-wake cycle. Consider pharmacological treatment (melatonin, low-dose quetiapine) in consultation with paediatric intensivist.
Interpretation bands for the pCAM-ICU. Apply clinical judgement and local guidance.
References
- Smith HAB, et al. Diagnosing delirium in critically ill children: validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit. Crit Care Med. 2011;39(1):150–157.
Related
Curated clinical cross-links plus same-class fallbacks.
- Melatonin · Melatonin Receptor Agonist
- Haloperidol (Delirium) · Typical Antipsychotic (Butyrophenone)
- Phytomenadione (Vitamin K1) · Vitamin K (Coagulation Factor Synthesis)
- Ibuprofen (Orthopaedic Musculoskeletal Pain) · NSAID — Non-selective COX Inhibitor
- Vitamin K (Phytomenadione) · Vitamin / Haemostatic
- Chloral Hydrate · Sedative (Procedural)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.
