Delirium in paediatrics: early detection, diagnosis and nursing care | Revista Científica de la Sociedad Española de Enfermería Neurológica (English ed.)

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] ] ] "textoCompleto" => "IntroductionDelirium is considered an acute brain dysfunction characterised by an altered state of consciousness due to fluctuating mental status, inattention, and the inability to receive, process, store or recall information. The true prevalence of delirium in the paediatric population is not well documented, however, the literature on children suggests that the symptoms of delirium in this population are similar to those in adults.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Delirium has been identified as a risk factor for mortality in critically ill patients, with greater social and economic impact, i.e., patients require more days of mechanical ventilation and a prolonged stay in the intensive care unit (ICU), increasing the medical costs of their hospitalisation.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The most frequent symptoms in children with possible delirium are disturbances, fluctuating symptoms, impaired attention, irritability, agitation, affective lability and confusion. The main causes of delirium are associated with infectious or inflammatory disorders. Predisposing factors include mechanical ventilation, benzodiazepine use, overdosage of sedation, sleep-wake cycle disturbances, narcotics, physical restraints, exposure to vasopressors and anticonvulsants.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Delirium can present in a variety of types according to psychomotor behaviour, ranging from: (1) hypoactive, where the patient is observed to be calm, quiet, with a fixed gaze; (2) hyperactive, where the patient is agitated, with hallucinations; or (3) mixed. Hypoactive delirium can be easily diagnosed given the typical characteristics of this subtype; however, it is associated with a poorer diagnosis in the critically ill child. There are methodological weaknesses of the instruments to diagnose delirium in the critically ill paediatric patient<a class="elsevierStyleCrossRef" href="#bib0020">4</a>; the prevalence of delirium in children ranges from 5%–10%, perhaps because the true prevalence of delirium in children is underestimated, given the absence of validated assessment methods to diagnose delirium in paediatric patients and the healthcare team’s limited knowledge to identify the symptoms of delirium in children in the Paediatric Intensive Care Unit (PICU).<a class="elsevierStyleCrossRef" href="#bib0025">5</a> The incidence and prevalence of delirium in paediatrics is low, as there are no well-validated instruments for clear and timely diagnosis at the bedside of the PICU patient.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>The nursing team is the ideal first-line care provider to assess the presence or absence of delirium. Knowledge of the importance of delirium screening and the ability to perform an accurate, rapid, and efficient assessment, which is consistent across the PICU, is of paramount importance in the care of the critically ill patient.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> Screening and early intervention for delirium is key to mitigating adverse outcomes in critically ill children. Non-pharmacological strategies rely on prevention, and the treatment of positive delirium screening.In view of the above, the presence of delirium in critically ill children is an underexplored area for research, as the data found in the literature come from small population studies that are biased and do not capture the true prevalence of delirium in this population. Therefore, the purpose of this integrative literature review is to present findings of early detection, diagnosis, pharmacological treatment, and nursing care of delirium in the paediatric patient in the intensive care unit.MethodologyAn integrative review was developed, in which the stages proposed by Cooper<a class="elsevierStyleCrossRef" href="#bib0040">8</a> were applied: (1) identification of the subject; (2) establishment of criteria for inclusion and exclusion of studies, sampling or search in the literature; (3) definition of the information to be extracted from the selected studies or categorisation of the studies; (4) evaluation of the studies included in the integrative review and (5) interpretation of the results.The search was performed in the PubMed, Web of Science, SCOPUS databases; articles with quantitative and qualitative methodology were analysed. The PICO scheme was used: Paediatric population with delirium and nursing care in the Intensive Care Unit. The descriptors PubMed (Intensive Care Units, pediatric) AND (Delirium) AND (Nursing Care); Scopus (intensive AND care AND units AND pediatric AND delirium AND nursing AND care) Web of Science (Intensive Care Units, pediatric AND Delirium AND Nursing Care) were combined using the Boolean operators "AND" and "OR" in English and Spanish.The search process was refined using the following filters: years 2011–2019; only those articles for which the full text was accessible through the means available to the authors were included. We also selected articles that met the following inclusion criteria: primary studies, articles published in Spanish and English; exclusion criteria: editorial articles, opinion articles, literature reviews, secondary studies such as systematic reviews, case studies and settings other than the intensive care unit. For the analysis and critical reading of the articles, the freely accessible templates of the Critical Appraisal Skills Programme in Spanish (CASPe) were used by three researchers independently, by means of an electronic form to record the results of the consistency checking of the studies included and evaluated, in which the objective or clinical characteristics, author, study design, context or country, year, participants (number, age, sex, etc.), delirium assessment tool and main result were noted.ResultsThe search in different databases produced a total of 85 references, after eliminating duplicate articles, 70 articles remained, whose titles and abstracts were evaluated by the reviewers. After this first phase, 55 articles were selected as potentially eligible, and the full text was read, again by blinded peers to assess its quality, extract data and determine whether or not to include it in the review, 15 studies were eventually selected for this review (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The findings of each of the articles reviewed emphasize early detection by using validated tools in the Paediatric Intensive Care Unit, in pharmacological treatment and interprofessional work (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Early detection by means of validated toolsIdentifying delirium is key to the implementation of interventions to reduce delirium-associated morbidity and mortality. Delirium is more likely to be determined if screening tools are used.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Screening for the presence of delirium in critically ill children should be undertaken within 12h following admission to the PICU. The diagnosis of delirium was initially made by child psychiatrists, but a psychiatric assessment, although reliable, is not available for use in all paediatric intensive care units; therefore there are three screening tools for the presence of delirium in critically ill paediatric patients: the Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU), the Pediatric Confusion Assessment Method for the Intensive Care Unit (psCAMICU), and the Cornell Assessment of Pediatric Delirium (CAPD).<a class="elsevierStyleCrossRef" href="#bib0050">10</a>Assessment tools differ in their methods and the age ranges in which they can be applied. The pCAM-ICU and psCAM-ICU have four features: (1) acute change or fluctuation from baseline mental status; (2) inattention; (3) altered level of consciousness; and (4) sleep-wake cycle disturbances. Screening is performed over a set period, starting with feature 1; if the answer is "Yes" to any of the questions, feature 1 is present, then move on to feature 2; if the answer is "Yes" to any of the questions, feature 2 is present, then move on to assess 3 and 4 to determine the presence of delirium.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a>The CAPD is used for critically ill children from birth to 21 years of age. The tool assesses eight behavioural items over the course of the first 12h, the items assessed are the signs and symptoms of hypoactive and hyperactive delirium based on consciousness, cognition, orientation, and psychomotor activity.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>Paediatric delirium is frequently underdiagnosed due to the difficulty in its assessment, diagnosis, and treatment. This makes the paediatric patient highly vulnerable and leads to increased morbidity and mortality rates. Furthermore, the symptoms of delirium can easily be confused with those of other disorders such as agitation and withdrawal syndrome. Therefore, it is important to know the different forms of assessment and diagnosis of each symptom to determine the diagnosis and treatment necessary.Sudden changes in behaviour, motor agitation and sleep-wake cycle disturbances are characteristic of the delirium process; these can also occur in other disorders accompanied by other symptoms such as iatrogenic withdrawal syndrome, where diarrhoea, vomiting and changes in temperature can also occur. To make a differential diagnosis, an assessment should be made using the Withdrawal Assessment Tool-1 (WAT-1) scale that evaluates withdrawal symptoms twice a day, or the Sophia Observation Withdrawal Symptoms-scale (SOS), comprising 15 items and developed based on the experience of experts with symptoms they consider relevant.<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a>The pain described in paediatric patients is mostly acute and location specific, there is greater vocal and facial expression of pain, the patient may show emotional and motor agitation as a way of expressing their discomfort. Tools used to assess pain in children have been widely documented and are successfully used in the clinical setting, such as the Neonatal Pain, Agitation and Sedation Scale (N-PASS) which is used to assess acute and prolonged pain in neonates and infants. The Face, Legs, Activity, Cry and Consolability (FLACC) tool was designed to assess pain in children between the ages of two months and seven years based on behavioural observations, and finally, the numerical rating scale used in children over the age of eight who can identify and assign a numerical value to their pain.<a class="elsevierStyleCrossRef" href="#bib0075">15</a>It is important to note the DSM-5 classifications for diagnosis: (A) Disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment); (B) The disturbance develops over a short period of time (usually hours to a few days), represents an acute change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day; (C) An additional disturbance in cognition (e.g. memory deficit, disorientation, language, visuospatial ability, or perception); (D) The disturbances in Criteria A and C are not better explained by a pre-existing, established or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal such as coma; and (E) There is evidence from the history, physical examination or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication), exposure to a toxin, or is due to multiple aetiologies.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>While multiple scales and diagnostic tools have proved quite accurate in the diagnosis of delirium, the importance of comprehensive assessment must be kept in mind, in which observation of the child's behaviour is the first step towards identifying whether there is any significant disturbance or change that is relevant to the healthcare provider.Pharmacological treatmentThe use of anaesthetics in children is associated with a high incidence of emergence agitation (EA) in a prospective double-blind trial. However, this state of agitation is linked to other factors, primarily the separation of the child from their parent during anaesthesia induction. Furthermore, the use of gabapentin was found to reduce the overall incidence and severity score of EA, and patients in the gabapentin group were found to be in a more drowsy state, however, no patients in this group or in the control group were found to be in an obtunded state; finally, the lack of clarity on dose is highlighted as a limitation.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> The involvement of multiple central nervous system pathways in the development of delirium suggests that pharmacotherapy with psychoactive agents, particularly quetiapine, is a physiologically reasonable option. Use of quetiapine remains limited due to potential severe adverse effects, and the need for a prospective double-blind, placebo-controlled trial before it is used as routine therapy in paediatric delirium.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>Interprofessional work and nursing careNursing care ranges from needs assessment to the emotional support for the patient and family that nurses can provide. Quality care requires both attitude and knowledge, which means a constant need for staff training, where nurses can acquire the knowledge to identify, differentiate and, to a lesser extent, treat the symptoms presented by their patient. This knowledge will make the difference between maintaining a patient and actually providing care.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Across the studies, we observe a need to implement a change in practice by identifying facilitators and barriers; lack of knowledge is a barrier, remembering to complete assessments, documentation outside workflow, and “busy patient”. Factors with high-risk prediction numbers were lack of time and paper charting.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>The facilitator would need to provide education throughout the implementation phase, therefore delirium screening tools should be included in assessment and recording as part of the clinical history, in other words, such tools should be readily available and easy to use. Bearing in mind that the detection and assessment of delirium must be carried out from a multidisciplinary approach.<a class="elsevierStyleCrossRef" href="#bib0100">20</a>The barriers include misconceptions about the treatment of delirium, recognising that benzodiazepines are an appropriate therapy for delirium and that children with delirium will have no memory of the experience.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>Regarding non-pharmacological treatment, delirium reduction has been demonstrated in paediatric intensive care unit patients aged from two to 18 years, thus showing a way forward for developing these strategies in the PICU.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> These strategies include interventions to address environmental triggers of delirium, sleep disruption, integrated family care and mobilisation. Environmental interventions are a preventive strategy used by nurses to reduce the prevalence and duration of delirium, addressing excessive noise, light, and sleep disruption. Nurses can minimise noise by adjusting the volume of alarms on monitors, infusion devices and other medical equipment, as well as limiting conversation inside and outside the room. Images of home, pets, family, and friends should be visible to the child and can reduce their fear and reorient them. Strategies to orient the older child include calendars and clocks. Sleep disruption can be minimised with a daytime and night-time schedule, by coordinating therapies with other team members to orient the critically ill patient.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>Integrated family care involves the presence of parents throughout the day. Nurses should educate parents about delirium and tactics for orienting and comforting their child. Comfort measures preferred by the child, such as their favourite music or toys, should be offered, and parental interventions include keeping a diary, participating in rounds, notifying the healthcare team of subtle changes in the patient, and passive movement.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>Play is a strategy to distract and support the child and family in the prevention of delirium, and early mobilisation is recommended as a preventive intervention to reduce the incidence and duration of delirium. Early mobilisation, therefore, is an intervention that can reduce the incidence and duration of delirium in the critically ill paediatric patient. Early mobilisation includes active range of movement, sitting on the edge of the bed, sitting in a chair or ambulation.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>The nurse should be aware of the adverse effects associated with antipsychotic medication and monitor the patient closely should they occur. Side effects include extrapyramidal movement disorder and cardiac arrhythmias, specifically a prolonged rate corrected QT-interval, which can lead to torsades de pointes and ultimately heart failure.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>It is important to inventory all pharmacological agents for each drug and discontinue any that are known to cause delirium or have high anticholinergic potential, because anticholinergic syndrome is involved in neurocognitive and behavioural risk processes, and midazolam with fentanyl should not be administered in the same solution or access route because this generates accumulation of these metabolites (almost double in patients without this infusion).<a class="elsevierStyleCrossRef" href="#bib0125">25</a>We recommend having and using the ICU ABCDEF bundle.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>A=Assess, Prevent and Manage painB=Both Spontaneous Awakening Trials and Spontaneous Breathing TrialsC=Choice of analgesia and sedationD=Delirium: Assess, Prevent and ManageE=Early mobility and ExerciseF=Family engagement and empowerment.ConclusionsThe main difficulty in the diagnosis and adequate treatment of delirium in the paediatric population is lack of knowledge; at the same time, this is a subject little researched in the literature, which flags up a potential knowledge gap. The diagnosis of delirium still generates confusion among health personnel, as many of the symptoms can be confused with those of other pathologies, which only makes treatment even more difficult.The limited literature found shows the need for research and training in paediatric delirium for both nursing and other healthcare staff. The importance of timely identification, prevention and treatment of delirium is largely recognised in the work setting; these patients are in the PICU where their real needs are highlighted, showing the need for research targeting this setting.The limitations of this study are that a language other than Spanish and English has not been included.Conflict of interestsThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1729738" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methodology" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1526947" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1729737" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Metodología" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1526946" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methodology" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Early detection by means of validated tools" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Pharmacological treatment" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Interprofessional work and nursing care" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-02-11" "fechaAceptado" => "2020-11-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1526947" "palabras" => array:4 [ 0 => "Delirium" 1 => "Paediatrics" 2 => "Critical illness" 3 => "Nursing" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1526946" "palabras" => array:4 [ 0 => "Delirium" 1 => "Pediatría" 2 => "Enfermedad crítica" 3 => "Enfermería" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionDelirium is the most frequent manifestation of central nervous system dysfunction, a fluctuating and acute cognitive alteration in the critically ill patient. ObjectiveTo analyse the scientific production about delirium in paediatric patients in the Intensive Care Unit on early detection, diagnosis, and nursing care. MethodologyAn integrative review of primary studies was conducted in three databases PubMed, Web of Science, SCOPUS, with the search strategy (Intensive Care Units, Paediatric) and (Delirium) and (Nursing Care), criteria of inclusion of primary studies published between 2011 and 2019, in English and Spanish available in full text. ResultsAfter analytical reading, 15 primary studies were selected, our results contribute to early detection, validated evaluation methods to diagnose delirium in Spanish-speaking paediatric patients such as PsCAM-ICU, PCAM-ICU and Cornell as well as nursing in the care of critical paediatric patients with the presence of delirium. ConclusionsCognitive assessment using validated scales in the paediatric patient allows the practice of the nursing professional in the paediatric unit to go beyond a series of instrumental tasks in the PICU and allows prevention to follow-up and control of cases in the delirious patient." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methodology" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl delirium es la manifestación más frecuente de la disfunción del sistema nervioso central, una alteración cognitiva fluctuante y aguda en el paciente en estado crítico. ObjetivoAnalizar la producción científica acerca del delírium en el paciente pediátrico en Unidad de Cuidados Intensivos sobre la detección precoz, diagnóstico y cuidados de enfermería. MetodologíaSe realizó una revisión integrativa, de estudios primarios en tres bases de datos PubMed, Web of Science, SCOPUS, con la estrategia de búsqueda (Intensive Care Units, Pediatric) And (Delirium) And (Nursign Care), criterios de inclusión estudios primarios publicados entre los años 2011al 2019, en idioma inglés y español disponible en texto completo. ResultadosDespués de la lectura analítica, 15 estudios primarios fueron seleccionados, cuyos resultados aportan a la detección precoz, los métodos de evaluación validados para diagnosticar el delirium en pacientes pediátricos de habla hispana como PsCAM-ICU, PCAM-ICU y Cornell igualmente el cuidado de enfermería a pacientes pediátricos críticos con presencia de delirium. ConclusionesLa valoración cognitiva por medio de escalas validadas en el paciente pediátrico permite que la práctica del profesional de enfermería en la unidad pediátrica vaya más allá de una serie de tareas instrumentales en la UCIP y permiten la prevención hasta el seguimiento y control de los casos en el paciente con delirium." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Metodología" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Henao-Castaño A, Monroy KN, Moreno JP, Pinzon Casas EY. Delírium en pediatría: detección precoz, diagnóstico y cuidado de enfermería. Rev Cient Soc Esp Enferm Neurol. 2022;55:17–24." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1901 "Ancho" => 2167 "Tamanyo" => 232588 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0200" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Data collection diagram.gr1 Source: data from the 2019 study." ] ] 1 => array:9 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: data from the 2019 study." "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0205" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference in the literature \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Objective \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Country \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Authors \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Design \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Analysis \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To determine the current knowledge level about delirium and its risk factors among PICU nurses prior to education \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Flaigle et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Descriptive survey \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nursing care Diagnostic tool \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To implement clinical management algorithms following testing and present the necessary incorporation of delirium as an outcome measure for future clinical trials in paediatric critical care medicine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gesin et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Descriptive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnostic tool \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To measure the impact of using the Intensive Care Delirium Screening Checklist (ICDSC), with or without a multi-facet education programme, on STICU nurses’ knowledge and perceptions of delirium and their ability to evaluate it correctly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smith et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Descriptive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnostic tool \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To determine the validity and reliability of a fundamentally objective and developmentally appropriate delirium assessment tool for critically ill infants and pre-school-aged children and to determine delirium prevalence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smith et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective observational \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnostic tool \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To validate a diagnostic instrument for paediatric delirium in critically ill children, both ventilated and nonventilated, that uses standardised, developmentally appropriate measurements \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smith et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnostic tests \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnostic tool \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To determine validity and reliability of the Cornell Assessment of Pediatric Delirium, a rapid observational screening tool \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Traube et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnostic tool \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To evaluate the measurement properties of the paediatric delirium component (PD-scale) of Sophia Observation Withdrawal Symptoms scale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Netherlands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ista et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multi-centre prospective observational \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnostic tool \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To understand the use of tools, protocols and comfort measures related to sedation/analgesia, and to screen the occurrence of delirium in paediatric intensive care units \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Brazil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Colleti Junior et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Survey \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-pharmacological treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To provide clinical recommendations for the assessment of pain, level of sedation, iatrogenic withdrawal syndrome and delirium in critically ill infants and children \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Netherlands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Harris et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Descriptive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pharmacological treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To examine the role of Gabapentin oral solution in attenuating desflurane associated EA (Emergence Agitation) in children after strabismus surgery under general anaesthesia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Egypt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Badawy et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pharmacological treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To determine whether treatment of hypoactive delirium with quetiapine reduces the duration of delirium compared with no pharmacologic treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Michaud et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective observational descriptive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nursing care \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To describe a quality improvement initiative to implement delirium assessment in a paediatric intensive care unit and to identify barriers to delirium screening completion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rohlik et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Descriptive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nursing care \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To implement delirium screening in a PICU. To evaluate the impact of multifaceted education on PICU nurses’ delirium knowledge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2019 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Norman and Taha \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Descriptive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nursing care \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surveying whether paediatric residents and nurses who care for patients in the intensive care setting would expose misunderstandings about delirium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2019 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">McGetrick et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Descriptive, Survey \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-pharmacological treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To evaluate the impact/effect of implementing nonpharmacologic nursing bundles on the incidence of paediatric delirium. It is not yet known whether or not bundles consistently reduce the incidence of delirium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Franken et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Descriptive, Survey \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-pharmacological treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In addition, the admission of children to the paediatric intensive care unit exposes them to a series of painful and stressful events that have a direct impact on the development of cognitive and behavioural functions, which in some cases are derived from pain, agitation, and delirium. Therefore, it is important to use pain assessment tools in the PICU to objectively identify the level of pain of critically ill paediatric patients and thus differentiate delirium from withdrawal syndrome and pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Simone et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Analytical observational \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-pharmacological treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To examine the impact of an ICU bundle on delirium. Detection and prevalence and to describe the characteristics of delirium cases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the 15 articles selected." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American Psychiatric Association" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "American Psychiatric Association" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "edicion" => "5th ed" "titulo" => "Diagnostic and statistical manual of mental disorders: DSM-5" "fecha" => "2013" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delirium in mechanically ventilated patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.W. Ely" 1 => "S.K. Inouye" 2 => "G.R. Bernard" 3 => "S. Gordon" 4 => "J. Francis" 5 => "L. May" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.286.21.2703" "Revista" => array:6 [ "tituloSerie" => "JAMA." "fecha" => "2001" "volumen" => "286" "numero" => "21" "paginaInicial" => "2703" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11730446" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.N.M. Schieveld" 1 => "J.A. van der Valk" 2 => "I. Smeets" 3 => "E. Berghmans" 4 => "R. Wassenberg" 5 => "P.L.M.N. 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Pandharipande" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pcl.2013.02.010" "Revista" => array:7 [ "tituloSerie" => "Pediatr Clin North Am" "fecha" => "2013" "volumen" => "60" "numero" => "3" "paginaInicial" => "741" "paginaFinal" => "760" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23639666" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost associated with pediatric delirium in the ICU" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Traube" 1 => "E.A. Mauer" 2 => "L.M. Gerber" 3 => "S. Kaur" 4 => "C. Joyce" 5 => "A. Kerson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med." "fecha" => "2016" "volumen" => "44" "numero" => "12" "paginaInicial" => "e1175" "paginaFinal" => "9" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric delirium: evaluation, management, and special considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Malas" 1 => "K. Brahmbhatt" 2 => "C. McDermott" 3 => "A. Smith" 4 => "R. Ortiz-Aguayo" 5 => "S. Turkel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Curr Psychiatry Rep." 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Delirium in paediatrics: early detection, diagnosis and nursing care

Delírium en pediatría: detección precoz, diagnóstico y cuidado de enfermería

Angela Henao-Castañoa,

Corresponding author

angmhenaocas@unal.edu.co

Corresponding author.

, Karen Natalia Monroyb, Jenny Paola Morenob, Edwar Yamith Pinzon Casasc

a Facultad de Enfermería de la Universidad Nacional de Colombia, Bogotá, Colombia

b Universidad Nacional de Colombia, Bogotá, Colombia

c Fundación Santa Fe de Bogotá, Bogotá, Colombia

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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Data collection diagram&#46;gr1</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Source&#58; data from the 2019 study&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Delirium is considered an acute brain dysfunction characterised by an altered state of consciousness due to fluctuating mental status&#44; inattention&#44; and the inability to receive&#44; process&#44; store or recall information&#46; The true prevalence of delirium in the paediatric population is not well documented&#44; however&#44; the literature on children suggests that the symptoms of delirium in this population are similar to those in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Delirium has been identified as a risk factor for mortality in critically ill patients&#44; with greater social and economic impact&#44; i&#46;e&#46;&#44; patients require more days of mechanical ventilation and a prolonged stay in the intensive care unit &#40;ICU&#41;&#44; increasing the medical costs of their hospitalisation&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The most frequent symptoms in children with possible delirium are disturbances&#44; fluctuating symptoms&#44; impaired attention&#44; irritability&#44; agitation&#44; affective lability and confusion&#46; The main causes of delirium are associated with infectious or inflammatory disorders&#46; Predisposing factors include mechanical ventilation&#44; benzodiazepine use&#44; overdosage of sedation&#44; sleep-wake cycle disturbances&#44; narcotics&#44; physical restraints&#44; exposure to vasopressors and anticonvulsants&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Delirium can present in a variety of types according to psychomotor behaviour&#44; ranging from&#58; &#40;1&#41; hypoactive&#44; where the patient is observed to be calm&#44; quiet&#44; with a fixed gaze&#59; &#40;2&#41; hyperactive&#44; where the patient is agitated&#44; with hallucinations&#59; or &#40;3&#41; mixed&#46; Hypoactive delirium can be easily diagnosed given the typical characteristics of this subtype&#59; however&#44; it is associated with a poorer diagnosis in the critically ill child&#46; There are methodological weaknesses of the instruments to diagnose delirium in the critically ill paediatric patient<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#59; the prevalence of delirium in children ranges from 5&#37;&#8211;10&#37;&#44; perhaps because the true prevalence of delirium in children is underestimated&#44; given the absence of validated assessment methods to diagnose delirium in paediatric patients and the healthcare team&#8217;s limited knowledge to identify the symptoms of delirium in children in the Paediatric Intensive Care Unit &#40;PICU&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The incidence and prevalence of delirium in paediatrics is low&#44; as there are no well-validated instruments for clear and timely diagnosis at the bedside of the PICU patient&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The nursing team is the ideal first-line care provider to assess the presence or absence of delirium&#46; Knowledge of the importance of delirium screening and the ability to perform an accurate&#44; rapid&#44; and efficient assessment&#44; which is consistent across the PICU&#44; is of paramount importance in the care of the critically ill patient&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Screening and early intervention for delirium is key to mitigating adverse outcomes in critically ill children&#46; Non-pharmacological strategies rely on prevention&#44; and the treatment of positive delirium screening&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In view of the above&#44; the presence of delirium in critically ill children is an underexplored area for research&#44; as the data found in the literature come from small population studies that are biased and do not capture the true prevalence of delirium in this population&#46; Therefore&#44; the purpose of this integrative literature review is to present findings of early detection&#44; diagnosis&#44; pharmacological treatment&#44; and nursing care of delirium in the paediatric patient in the intensive care unit&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methodology</span><p id="par0020" class="elsevierStylePara elsevierViewall">An integrative review was developed&#44; in which the stages proposed by Cooper<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> were applied&#58; &#40;1&#41; identification of the subject&#59; &#40;2&#41; establishment of criteria for inclusion and exclusion of studies&#44; sampling or search in the literature&#59; &#40;3&#41; definition of the information to be extracted from the selected studies or categorisation of the studies&#59; &#40;4&#41; evaluation of the studies included in the integrative review and &#40;5&#41; interpretation of the results&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The search was performed in the PubMed&#44; Web of Science&#44; SCOPUS databases&#59; articles with quantitative and qualitative methodology were analysed&#46; The PICO scheme was used&#58; Paediatric population with delirium and nursing care in the Intensive Care Unit&#46; The descriptors PubMed &#40;Intensive Care Units&#44; pediatric&#41; AND &#40;Delirium&#41; AND &#40;Nursing Care&#41;&#59; Scopus &#40;intensive AND care AND units AND pediatric AND delirium AND nursing AND care&#41; Web of Science &#40;Intensive Care Units&#44; pediatric AND Delirium AND Nursing Care&#41; were combined using the Boolean operators &#34;AND&#34; and &#34;OR&#34; in English and Spanish&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The search process was refined using the following filters&#58; years 2011&#8211;2019&#59; only those articles for which the full text was accessible through the means available to the authors were included&#46; We also selected articles that met the following inclusion criteria&#58; primary studies&#44; articles published in Spanish and English&#59; exclusion criteria&#58; editorial articles&#44; opinion articles&#44; literature reviews&#44; secondary studies such as systematic reviews&#44; case studies and settings other than the intensive care unit&#46; For the analysis and critical reading of the articles&#44; the freely accessible templates of the Critical Appraisal Skills Programme in Spanish &#40;CASPe&#41; were used by three researchers independently&#44; by means of an electronic form to record the results of the consistency checking of the studies included and evaluated&#44; in which the objective or clinical characteristics&#44; author&#44; study design&#44; context or country&#44; year&#44; participants &#40;number&#44; age&#44; sex&#44; etc&#46;&#41;&#44; delirium assessment tool and main result were noted&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">The search in different databases produced a total of 85 references&#44; after eliminating duplicate articles&#44; 70 articles remained&#44; whose titles and abstracts were evaluated by the reviewers&#46; After this first phase&#44; 55 articles were selected as potentially eligible&#44; and the full text was read&#44; again by blinded peers to assess its quality&#44; extract data and determine whether or not to include it in the review&#44; 15 studies were eventually selected for this review &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The findings of each of the articles reviewed emphasize early detection by using validated tools in the Paediatric Intensive Care Unit&#44; in pharmacological treatment and interprofessional work &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Early detection by means of validated tools</span><p id="par0045" class="elsevierStylePara elsevierViewall">Identifying delirium is key to the implementation of interventions to reduce delirium-associated morbidity and mortality&#46; Delirium is more likely to be determined if screening tools are used&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Screening for the presence of delirium in critically ill children should be undertaken within 12<span class="elsevierStyleHsp" style=""></span>h following admission to the PICU&#46; The diagnosis of delirium was initially made by child psychiatrists&#44; but a psychiatric assessment&#44; although reliable&#44; is not available for use in all paediatric intensive care units&#59; therefore there are three screening tools for the presence of delirium in critically ill paediatric patients&#58; the Pediatric Confusion Assessment Method for the Intensive Care Unit &#40;pCAM-ICU&#41;&#44; the Pediatric Confusion Assessment Method for the Intensive Care Unit &#40;psCAMICU&#41;&#44; and the Cornell Assessment of Pediatric Delirium &#40;CAPD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Assessment tools differ in their methods and the age ranges in which they can be applied&#46; The pCAM-ICU and psCAM-ICU have four features&#58; &#40;1&#41; acute change or fluctuation from baseline mental status&#59; &#40;2&#41; inattention&#59; &#40;3&#41; altered level of consciousness&#59; and &#40;4&#41; sleep-wake cycle disturbances&#46; Screening is performed over a set period&#44; starting with feature 1&#59; if the answer is &#34;Yes&#34; to any of the questions&#44; feature 1 is present&#44; then move on to feature 2&#59; if the answer is &#34;Yes&#34; to any of the questions&#44; feature 2 is present&#44; then move on to assess 3 and 4 to determine the presence of delirium&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The CAPD is used for critically ill children from birth to 21 years of age&#46; The tool assesses eight behavioural items over the course of the first 12<span class="elsevierStyleHsp" style=""></span>h&#44; the items assessed are the signs and symptoms of hypoactive and hyperactive delirium based on consciousness&#44; cognition&#44; orientation&#44; and psychomotor activity&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Paediatric delirium is frequently underdiagnosed due to the difficulty in its assessment&#44; diagnosis&#44; and treatment&#46; This makes the paediatric patient highly vulnerable and leads to increased morbidity and mortality rates&#46; Furthermore&#44; the symptoms of delirium can easily be confused with those of other disorders such as agitation and withdrawal syndrome&#46; Therefore&#44; it is important to know the different forms of assessment and diagnosis of each symptom to determine the diagnosis and treatment necessary&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Sudden changes in behaviour&#44; motor agitation and sleep-wake cycle disturbances are characteristic of the delirium process&#59; these can also occur in other disorders accompanied by other symptoms such as iatrogenic withdrawal syndrome&#44; where diarrhoea&#44; vomiting and changes in temperature can also occur&#46; To make a differential diagnosis&#44; an assessment should be made using the Withdrawal Assessment Tool-1 &#40;WAT-1&#41; scale that evaluates withdrawal symptoms twice a day&#44; or the Sophia Observation Withdrawal Symptoms-scale &#40;SOS&#41;&#44; comprising 15 items and developed based on the experience of experts with symptoms they consider relevant&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The pain described in paediatric patients is mostly acute and location specific&#44; there is greater vocal and facial expression of pain&#44; the patient may show emotional and motor agitation as a way of expressing their discomfort&#46; Tools used to assess pain in children have been widely documented and are successfully used in the clinical setting&#44; such as the Neonatal Pain&#44; Agitation and Sedation Scale &#40;N-PASS&#41; which is used to assess acute and prolonged pain in neonates and infants&#46; The Face&#44; Legs&#44; Activity&#44; Cry and Consolability &#40;FLACC&#41; tool was designed to assess pain in children between the ages of two months and seven years based on behavioural observations&#44; and finally&#44; the numerical rating scale used in children over the age of eight who can identify and assign a numerical value to their pain&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">It is important to note the DSM-5 classifications for diagnosis&#58; &#40;A&#41; Disturbance in attention &#40;i&#46;e&#46;&#44; reduced ability to direct&#44; focus&#44; sustain&#44; and shift attention&#41; and awareness &#40;reduced orientation to the environment&#41;&#59; &#40;B&#41; The disturbance develops over a short period of time &#40;usually hours to a few days&#41;&#44; represents an acute change from baseline attention and awareness&#44; and tends to fluctuate in severity during the course of a day&#59; &#40;<span class="elsevierStyleSmallCaps">C</span>&#41; An additional disturbance in cognition &#40;e&#46;g&#46; memory deficit&#44; disorientation&#44; language&#44; visuospatial ability&#44; or perception&#41;&#59; &#40;D&#41; The disturbances in Criteria A and C are not better explained by a pre-existing&#44; established or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal such as coma&#59; and &#40;E&#41; There is evidence from the history&#44; physical examination or laboratory findings that the disturbance is a direct physiological consequence of another medical condition&#44; substance intoxication or withdrawal &#40;i&#46;e&#46;&#44; due to a drug of abuse or to a medication&#41;&#44; exposure to a toxin&#44; or is due to multiple aetiologies&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">While multiple scales and diagnostic tools have proved quite accurate in the diagnosis of delirium&#44; the importance of comprehensive assessment must be kept in mind&#44; in which observation of the child&#39;s behaviour is the first step towards identifying whether there is any significant disturbance or change that is relevant to the healthcare provider&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Pharmacological treatment</span><p id="par0085" class="elsevierStylePara elsevierViewall">The use of anaesthetics in children is associated with a high incidence of emergence agitation &#40;EA&#41; in a prospective double-blind trial&#46; However&#44; this state of agitation is linked to other factors&#44; primarily the separation of the child from their parent during anaesthesia induction&#46; Furthermore&#44; the use of gabapentin was found to reduce the overall incidence and severity score of EA&#44; and patients in the gabapentin group were found to be in a more drowsy state&#44; however&#44; no patients in this group or in the control group were found to be in an obtunded state&#59; finally&#44; the lack of clarity on dose is highlighted as a limitation&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The involvement of multiple central nervous system pathways in the development of delirium suggests that pharmacotherapy with psychoactive agents&#44; particularly quetiapine&#44; is a physiologically reasonable option&#46; Use of quetiapine remains limited due to potential severe adverse effects&#44; and the need for a prospective double-blind&#44; placebo-controlled trial before it is used as routine therapy in paediatric delirium&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Interprofessional work and nursing care</span><p id="par0090" class="elsevierStylePara elsevierViewall">Nursing care ranges from needs assessment to the emotional support for the patient and family that nurses can provide&#46; Quality care requires both attitude and knowledge&#44; which means a constant need for staff training&#44; where nurses can acquire the knowledge to identify&#44; differentiate and&#44; to a lesser extent&#44; treat the symptoms presented by their patient&#46; This knowledge will make the difference between maintaining a patient and actually providing care&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Across the studies&#44; we observe a need to implement a change in practice by identifying facilitators and barriers&#59; lack of knowledge is a barrier&#44; remembering to complete assessments&#44; documentation outside workflow&#44; and &#8220;busy patient&#8221;&#46; Factors with high-risk prediction numbers were lack of time and paper charting&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The facilitator would need to provide education throughout the implementation phase&#44; therefore delirium screening tools should be included in assessment and recording as part of the clinical history&#44; in other words&#44; such tools should be readily available and easy to use&#46; Bearing in mind that the detection and assessment of delirium must be carried out from a multidisciplinary approach&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The barriers include misconceptions about the treatment of delirium&#44; recognising that benzodiazepines are an appropriate therapy for delirium and that children with delirium will have no memory of the experience&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Regarding non-pharmacological treatment&#44; delirium reduction has been demonstrated in paediatric intensive care unit patients aged from two to 18 years&#44; thus showing a way forward for developing these strategies in the PICU&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> These strategies include interventions to address environmental triggers of delirium&#44; sleep disruption&#44; integrated family care and mobilisation&#46; Environmental interventions are a preventive strategy used by nurses to reduce the prevalence and duration of delirium&#44; addressing excessive noise&#44; light&#44; and sleep disruption&#46; Nurses can minimise noise by adjusting the volume of alarms on monitors&#44; infusion devices and other medical equipment&#44; as well as limiting conversation inside and outside the room&#46; Images of home&#44; pets&#44; family&#44; and friends should be visible to the child and can reduce their fear and reorient them&#46; Strategies to orient the older child include calendars and clocks&#46; Sleep disruption can be minimised with a daytime and night-time schedule&#44; by coordinating therapies with other team members to orient the critically ill patient&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Integrated family care involves the presence of parents throughout the day&#46; Nurses should educate parents about delirium and tactics for orienting and comforting their child&#46; Comfort measures preferred by the child&#44; such as their favourite music or toys&#44; should be offered&#44; and parental interventions include keeping a diary&#44; participating in rounds&#44; notifying the healthcare team of subtle changes in the patient&#44; and passive movement&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Play is a strategy to distract and support the child and family in the prevention of delirium&#44; and early mobilisation is recommended as a preventive intervention to reduce the incidence and duration of delirium&#46; Early mobilisation&#44; therefore&#44; is an intervention that can reduce the incidence and duration of delirium in the critically ill paediatric patient&#46; Early mobilisation includes active range of movement&#44; sitting on the edge of the bed&#44; sitting in a chair or ambulation&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The nurse should be aware of the adverse effects associated with antipsychotic medication and monitor the patient closely should they occur&#46; Side effects include extrapyramidal movement disorder and cardiac arrhythmias&#44; specifically a prolonged rate corrected QT-interval&#44; which can lead to torsades de pointes and ultimately heart failure&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">It is important to inventory all pharmacological agents for each drug and discontinue any that are known to cause delirium or have high anticholinergic potential&#44; because anticholinergic syndrome is involved in neurocognitive and behavioural risk processes&#44; and midazolam with fentanyl should not be administered in the same solution or access route because this generates accumulation of these metabolites &#40;almost double in patients without this infusion&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">We recommend having and using the ICU ABCDEF bundle&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">A<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Assess&#44; Prevent and Manage pain</p><p id="par0145" class="elsevierStylePara elsevierViewall">B<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Both Spontaneous Awakening Trials and Spontaneous Breathing Trials</p><p id="par0150" class="elsevierStylePara elsevierViewall">C<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Choice of analgesia and sedation</p><p id="par0155" class="elsevierStylePara elsevierViewall">D<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Delirium&#58; Assess&#44; Prevent and Manage</p><p id="par0160" class="elsevierStylePara elsevierViewall">E<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Early mobility and Exercise</p><p id="par0165" class="elsevierStylePara elsevierViewall">F<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Family engagement and empowerment&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0170" class="elsevierStylePara elsevierViewall">The main difficulty in the diagnosis and adequate treatment of delirium in the paediatric population is lack of knowledge&#59; at the same time&#44; this is a subject little researched in the literature&#44; which flags up a potential knowledge gap&#46; The diagnosis of delirium still generates confusion among health personnel&#44; as many of the symptoms can be confused with those of other pathologies&#44; which only makes treatment even more difficult&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The limited literature found shows the need for research and training in paediatric delirium for both nursing and other healthcare staff&#46; The importance of timely identification&#44; prevention and treatment of delirium is largely recognised in the work setting&#59; these patients are in the PICU where their real needs are highlighted&#44; showing the need for research targeting this setting&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The limitations of this study are that a language other than Spanish and English has not been included&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interests</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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              "identificador" => "sec0020"
              "titulo" => "Early detection by means of validated tools"
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              "titulo" => "Pharmacological treatment"
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              "identificador" => "sec0030"
              "titulo" => "Interprofessional work and nursing care"
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    "fechaRecibido" => "2020-02-11"
    "fechaAceptado" => "2020-11-11"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1526947"
          "palabras" => array:4 [
            0 => "Delirium"
            1 => "Paediatrics"
            2 => "Critical illness"
            3 => "Nursing"
          ]
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1526946"
          "palabras" => array:4 [
            0 => "Delirium"
            1 => "Pediatr&#237;a"
            2 => "Enfermedad cr&#237;tica"
            3 => "Enfermer&#237;a"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Delirium is the most frequent manifestation of central nervous system dysfunction&#44; a fluctuating and acute cognitive alteration in the critically ill patient&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To analyse the scientific production about delirium in paediatric patients in the Intensive Care Unit on early detection&#44; diagnosis&#44; and nursing care&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methodology</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">An integrative review of primary studies was conducted in three databases PubMed&#44; Web of Science&#44; SCOPUS&#44; with the search strategy &#40;Intensive Care Units&#44; Paediatric&#41; and &#40;Delirium&#41; and &#40;Nursing Care&#41;&#44; criteria of inclusion of primary studies published between 2011 and 2019&#44; in English and Spanish available in full text&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">After analytical reading&#44; 15 primary studies were selected&#44; our results contribute to early detection&#44; validated evaluation methods to diagnose delirium in Spanish-speaking paediatric patients such as PsCAM-ICU&#44; PCAM-ICU and Cornell as well as nursing in the care of critical paediatric patients with the presence of delirium&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Cognitive assessment using validated scales in the paediatric patient allows the practice of the nursing professional in the paediatric unit to go beyond a series of instrumental tasks in the PICU and allows prevention to follow-up and control of cases in the delirious patient&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objective"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methodology"
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            "identificador" => "abst0020"
            "titulo" => "Results"
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            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El delirium es la manifestaci&#243;n m&#225;s frecuente de la disfunci&#243;n del sistema nervioso central&#44; una alteraci&#243;n cognitiva fluctuante y aguda en el paciente en estado cr&#237;tico&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Analizar la producci&#243;n cient&#237;fica acerca del del&#237;rium en el paciente pedi&#225;trico en Unidad de Cuidados Intensivos sobre la detecci&#243;n precoz&#44; diagn&#243;stico y cuidados de enfermer&#237;a&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Metodolog&#237;a</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una revisi&#243;n integrativa&#44; de estudios primarios en tres bases de datos PubMed&#44; Web of Science&#44; SCOPUS&#44; con la estrategia de b&#250;squeda &#40;Intensive Care Units&#44; Pediatric&#41; And &#40;Delirium&#41; And &#40;Nursign Care&#41;&#44; criterios de inclusi&#243;n estudios primarios publicados entre los a&#241;os 2011<span class="elsevierStyleHsp" style=""></span>al 2019&#44; en idioma ingl&#233;s y espa&#241;ol disponible en texto completo&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Despu&#233;s de la lectura anal&#237;tica&#44; 15 estudios primarios fueron seleccionados&#44; cuyos resultados aportan a la detecci&#243;n precoz&#44; los m&#233;todos de evaluaci&#243;n validados para diagnosticar el delirium en pacientes pedi&#225;tricos de habla hispana como PsCAM-ICU&#44; PCAM-ICU y Cornell igualmente el cuidado de enfermer&#237;a a pacientes pedi&#225;tricos cr&#237;ticos con presencia de delirium&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La valoraci&#243;n cognitiva por medio de escalas validadas en el paciente pedi&#225;trico permite que la pr&#225;ctica del profesional de enfermer&#237;a en la unidad pedi&#225;trica vaya m&#225;s all&#225; de una serie de tareas instrumentales en la UCIP y permiten la prevenci&#243;n hasta el seguimiento y control de los casos en el paciente con delirium&#46;</p></span>"
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            "titulo" => "Resultados"
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            "titulo" => "Conclusiones"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Henao-Casta&#241;o A&#44; Monroy KN&#44; Moreno JP&#44; Pinzon Casas EY&#46; Del&#237;rium en pediatr&#237;a&#58; detecci&#243;n precoz&#44; diagn&#243;stico y cuidado de enfermer&#237;a&#46; Rev Cient Soc Esp Enferm Neurol&#46; 2022&#59;55&#58;17&#8211;24&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Data collection diagram&#46;gr1</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Source&#58; data from the 2019 study&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference in the literature&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Objective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Authors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the current knowledge level about delirium and its risk factors among PICU nurses prior to education&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Flaigle et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Descriptive survey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nursing care Diagnostic tool&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To implement clinical management algorithms following testing and present the necessary incorporation of delirium as an outcome measure for future clinical trials in paediatric critical care medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gesin et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Descriptive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diagnostic tool&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To measure the impact of using the Intensive Care Delirium Screening Checklist &#40;ICDSC&#41;&#44; with or without a multi-facet education programme&#44; on STICU nurses&#8217; knowledge and perceptions of delirium and their ability to evaluate it correctly&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smith et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Descriptive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diagnostic tool&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the validity and reliability of a fundamentally objective and developmentally appropriate delirium assessment tool for critically ill infants and pre-school-aged children and to determine delirium prevalence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smith et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective observational&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diagnostic tool&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To validate a diagnostic instrument for paediatric delirium in critically ill children&#44; both ventilated and nonventilated&#44; that uses standardised&#44; developmentally appropriate measurements&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smith et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diagnostic tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diagnostic tool&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine validity and reliability of the Cornell Assessment of Pediatric Delirium&#44; a rapid observational screening tool&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Traube et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinical trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diagnostic tool&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To evaluate the measurement properties of the paediatric delirium component &#40;PD-scale&#41; of Sophia Observation Withdrawal Symptoms scale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Netherlands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ista et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multi-centre prospective observational&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diagnostic tool&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To understand the use of tools&#44; protocols and comfort measures related to sedation&#47;analgesia&#44; and to screen the occurrence of delirium in paediatric intensive care units&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brazil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colleti Junior et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Survey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-pharmacological treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To provide clinical recommendations for the assessment of pain&#44; level of sedation&#44; iatrogenic withdrawal syndrome and delirium in critically ill infants and children&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Netherlands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Harris et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Descriptive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pharmacological treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To examine the role of Gabapentin oral solution in attenuating desflurane associated EA &#40;Emergence Agitation&#41; in children after strabismus surgery under general anaesthesia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Egypt&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Badawy et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinical trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pharmacological treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine whether treatment of hypoactive delirium with quetiapine reduces the duration of delirium compared with no pharmacologic treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Michaud et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective observational descriptive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nursing care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To describe a quality improvement initiative to implement delirium assessment in a paediatric intensive care unit and to identify barriers to delirium screening completion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rohlik et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Descriptive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nursing care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To implement delirium screening in a PICU&#46; To evaluate the impact of multifaceted education on PICU nurses&#8217; delirium knowledge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Norman and Taha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Descriptive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nursing care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surveying whether paediatric residents and nurses who care for patients in the intensive care setting would expose misunderstandings about delirium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">McGetrick et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Descriptive&#44; Survey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-pharmacological treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To evaluate the impact&#47;effect of implementing nonpharmacologic nursing bundles on the incidence of paediatric delirium&#46; It is not yet known whether or not bundles consistently reduce the incidence of delirium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Franken et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Descriptive&#44; Survey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-pharmacological treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In addition&#44; the admission of children to the paediatric intensive care unit exposes them to a series of painful and stressful events that have a direct impact on the development of cognitive and behavioural functions&#44; which in some cases are derived from pain&#44; agitation&#44; and delirium&#46; Therefore&#44; it is important to use pain assessment tools in the PICU to objectively identify the level of pain of critically ill paediatric patients and thus differentiate delirium from withdrawal syndrome and pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Simone et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Analytical observational&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-pharmacological treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To examine the impact of an ICU bundle on delirium&#46; Detection and prevalence and to describe the characteristics of delirium cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the 15 articles selected&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:26 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "American Psychiatric Association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "American Psychiatric Association"
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                    0 => array:1 [
                      "Libro" => array:3 [
                        "edicion" => "5th ed"
                        "titulo" => "Diagnostic and statistical manual of mental disorders&#58; DSM-5"
                        "fecha" => "2013"
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                  ]
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              ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delirium in mechanically ventilated patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;W&#46; Ely"
                            1 => "S&#46;K&#46; Inouye"
                            2 => "G&#46;R&#46; Bernard"
                            3 => "S&#46; Gordon"
                            4 => "J&#46; Francis"
                            5 => "L&#46; May"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.286.21.2703"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA&#46;"
                        "fecha" => "2001"
                        "volumen" => "286"
                        "numero" => "21"
                        "paginaInicial" => "2703"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11730446"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic considerations regarding pediatric delirium&#58; a review and a proposal for an algorithm for pediatric intensive care units"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;N&#46;M&#46; Schieveld"
                            1 => "J&#46;A&#46; van der Valk"
                            2 => "I&#46; Smeets"
                            3 => "E&#46; Berghmans"
                            4 => "R&#46; Wassenberg"
                            5 => "P&#46;L&#46;M&#46;N&#46; Leroy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med&#46;"
                        "fecha" => "2009"
                        "volumen" => "35"
                        "numero" => "11"
                        "paginaInicial" => "1843"
                        "paginaFinal" => "1849"
                      ]
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                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric delirium&#46; monitoring and management in the pediatric intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46;A&#46;B&#46; Smith"
                            1 => "E&#46; Brink"
                            2 => "D&#46;C&#46; Fuchs"
                            3 => "E&#46;W&#46; Ely"
                            4 => "P&#46;P&#46; Pandharipande"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pcl.2013.02.010"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatr Clin North Am"
                        "fecha" => "2013"
                        "volumen" => "60"
                        "numero" => "3"
                        "paginaInicial" => "741"
                        "paginaFinal" => "760"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23639666"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost associated with pediatric delirium in the ICU"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Traube"
                            1 => "E&#46;A&#46; Mauer"
                            2 => "L&#46;M&#46; Gerber"
                            3 => "S&#46; Kaur"
                            4 => "C&#46; Joyce"
                            5 => "A&#46; Kerson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med&#46;"
                        "fecha" => "2016"
                        "volumen" => "44"
                        "numero" => "12"
                        "paginaInicial" => "e1175"
                        "paginaFinal" => "9"
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            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric delirium&#58; evaluation&#44; management&#44; and special considerations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Malas"
                            1 => "K&#46; Brahmbhatt"
                            2 => "C&#46; McDermott"
                            3 => "A&#46; Smith"
                            4 => "R&#46; Ortiz-Aguayo"
                            5 => "S&#46; Turkel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Curr Psychiatry Rep&#46;"
                        "fecha" => "2017"
                        "volumen" => "19"
                        "numero" => "9"
                        "paginaInicial" => "65"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identifying barriers to delirium screening and prevention in the pediatric ICU&#58; evaluation of PICU staff knowledge"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;C&#46; Flaigle"
                            1 => "J&#46; Ascenzi"
                            2 => "R&#46;K&#46; Sapna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Nurs &#91;Internet&#93;"
                        "fecha" => "2016"
                        "volumen" => "31"
                        "numero" => "1"
                        "paginaInicial" => "81"
                        "paginaFinal" => "84"
                      ]
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            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The integrative research review&#58; a systematic approach sage publications&#58; Beverly Hills"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; Cooper"
                          ]
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                      ]
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                  ]
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                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "1984"
                        "paginaInicial" => "143"
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            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of a delirium screening tool and multifaceted education on nurses&#8217; knowledge of delirium and ability to evaluate it correctly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46; Gesin"
                            1 => "B&#46;B&#46; Russell"
                            2 => "A&#46;P&#46; Lin"
                            3 => "H&#46;J&#46; Norton"
                            4 => "S&#46;L&#46; Evans"
                            5 => "J&#46;W&#46; Devlin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4037/ajcc2012605"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Crit Care&#46;"
                        "fecha" => "2012"
                        "volumen" => "21"
                        "numero" => "1"
                        "paginaInicial" => "e1"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22210704"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delirium&#58; An emerging frontier in the management of critically ill children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46;A&#46;B&#46; Smith"
                            1 => "D&#46;C&#46; Fuchs"
                            2 => "P&#46;P&#46; Pandharipande"
                            3 => "F&#46;E&#46; Barr"
                            4 => "E&#46;W&#46; Ely"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.anclin.2011.09.011"
                      "Revista" => array:7 [
                        "tituloSerie" => "Anesthesiol Clin&#46;"
                        "fecha" => "2011"
                        "volumen" => "29"
                        "numero" => "4"
                        "paginaInicial" => "729"
                        "paginaFinal" => "750"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22078920"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The preschool confusion assessment method for the ICU&#58; valid and reliable delirium monitoring for critically ill infants and children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;A&#46;B&#46; Smith"
                            1 => "M&#46; Gangopadhyay"
                            2 => "C&#46;M&#46; Goben"
                            3 => "N&#46;L&#46; Jacobowski"
                            4 => "M&#46;H&#46; Chestnut"
                            5 => "S&#46; Savage"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0000000000001428"
                      "Revista" => array:7 [
                        "tituloSerie" => "Crit Care Med&#46;"
                        "fecha" => "2016"
                        "volumen" => "44"
                        "numero" => "3"
                        "paginaInicial" => "592"
                        "paginaFinal" => "600"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26565631"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
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Article information

ISSN: 2530299X
Original language: English

DOI:10.1016/j.sedeng.2020.11.002

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