Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU)
What It Measures
The pCAM-ICU checks whether a critically ill child has delirium. Delirium is common in intensive care and easily mistaken for distress, sedation, or simply being unwell, and children who cannot speak because they are intubated are especially likely to be missed.
Arousal is checked first with the RASS sedation scale; a child at -4 or -5 is too deeply sedated to assess. If they are arousable, four features follow: whether mental status has changed from baseline or fluctuated, whether the child can sustain attention, whether their level of consciousness is anything other than alert and calm, and whether their thinking is disorganized. Delirium is present when features 1 and 2 are both positive, plus either 3 or 4.
Additional Notes
Licensing Notes: Materials are downloadable free from icudelirium.org — confirm before reproducing the flowsheet or embedding it in an EHR.
Learn More: Two limits: the pCAM-ICU requires a developmental age of at least 5, not just a chronological one, and it has not been validated in children with developmental delays. For younger children, the psCAM-ICU covers developmental ages 6 months to 5 years.