Adaptação transcultural e validação da ferramenta pCAM-ICU para diagnóstico de delirium em Unidades de Terapia Intensiva Pediátrica brasileiras

Abstract

Delirium is believed to be a still underdiagnosed syndrome in Pediatric Intensive Care Units (PICUs).The validation of a tool in Brazilian Portuguese for delirium diagnosis in these units can avoid its underdiagnosis in Brazil, allowing early treatment and reducing the permanence in mechanical ventilation, length of hospital stay and mortality, costs of hospitalization and risk of sequelae. The general objective of this thesis was to carry out studies of cross-cultural adaptation, reliability and validity of the Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU) already translated into the Brazilian Portuguese for the diagnosis of delirium in the PICU. The specific objectives were: to describe the incidence of delirium in the routine of three PICUs before the use of a diagnostic tool; perform the semantic equivalence and operational equivalence of the pCAM-ICU version already translated into Portuguese; evaluate the interrater reliability and criteria validity of this version. The first stage estimated the detection of delirium episodes in three PICUs, without the use of a diagnostic tool. A total of 477 patients (504 admissions) were included. The incidence of delirium was 0.4%. This low incidence seems to corroborate the literature's statement that delirium is underdiagnosed in Pediatrics. In the second stage, the cross-cultural adaptation of the pCAM-ICU translated into Brazilian Portuguese was carried out. The translated version was submitted to a consensus of six experts. After that, a pre-test was applied in 30 patients. The Brazilian version of pCAM-ICU was obtained according to international recommendations. The third stage consisted of a prospective cross-sectional observational study in eight PICUs with a convenience sample (n=116 patients), 5 17 years of age, with no developmental delay and submitted to mechanical ventilation or not. For interrater reliability, two previously trained researchers applied concomitant the pCAM-ICU and independently assessed the same patient. For criterion validity, a pediatric neurologist or a psychiatrist blinded to pCAM-ICU assessments evaluated the same patient within 30 minutes using the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition DSM-5 (gold standard). One hundred and forty-nine paired assessments were included. The sensitivity of pCAM-ICU was 90.9% (95% CI, 58.7 99.8%), the specificity was 99.3% (95% CI, 96 100%) and the interrater reliability was very high (κ = 1.0). The Brazilian version of pCAM-ICU is valid and reliable for use in Brazil for delirium diagnosis in children 5 years of age or older, without cognitive developmental delay.