Validation of the SOS-PD scale for assessment of pediatric delirium: a multicenter study

Erwin Ista*, Babette van Beusekom, Joost van Rosmalen, Martin C. J. Kneyber, Joris Lemson, Arno Brouwers, Gwen C. Dieleman, Bram Dierckx, Matthijs de Hoog, Dick Tibboel, Monique van Dijk

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Backgrounds: Reports of increasing incidence rates of delirium in critically ill children are reason for concern. We evaluated the measurement properties of the pediatric delirium component (PD-scale) of the Sophia Observation Withdrawal Symptoms scale Pediatric Delirium scale (SOS-PD scale). Methods: In a multicenter prospective observational study in four Dutch pediatric ICUs (PICUs), patients aged >= 3 months and admitted for >= 48 h were assessed with the PD-scale thrice daily. Criterion validity was assessed: if the PD-scale score was >= 4, a child psychiatrist clinically assessed the presence or absence of PD according to the Diagnostic and statistical manual of mental disorders (DSM)-IV. In addition, the child psychiatrist assessed a randomly selected group to establish the false-negative rate. The construct validity was assessed by calculating the Pearson coefficient (r(p)) for correlation between the PD-scale and Cornell Assessment Pediatric Delirium (CAP-D) scores. Interrater reliability was determined by comparing paired nurse-researcher PD-scale assessments and calculating the intraclass correlation coefficient (ICC). Results: Four hundred eighty-five patients with a median age of 27.0 months (IQR 8-102) were included, of whom 48 patients were diagnosed with delirium by the child psychiatrist. The PD-scale had overall sensitivity of 92.3% and specificity of 96.5% compared to the psychiatrist diagnosis for a cutoff score >= 4 points. The r(p) between the PD-scale and the CAP-D was 0.89 (CI 95%, 0.82-0.93; p < 0.001). The ICC of 75 paired nurse-researcher observations was 0.99 (95% CI, 0.98-0.99). Conclusions: The PD-scale has good reliability and validity for early screening of PD in critically ill children. It can be validly and reliably used by nurses to this aim.
Original languageEnglish
Article number309
Number of pages11
JournalCritical Care
Publication statusPublished - 20 Nov 2018


  • Pediatric delirium
  • Assessment tool
  • Iatrogenic withdrawal syndrome (IWS)
  • Benzodiazepine
  • Sedation
  • PICU

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