CAPD: Cornell Assessment of Pediatric Delirium

2014

Rapid observational nursing screen for delirium across the full paediatric age range in the PICU.

At a glance

Purpose: Episodic assessment
Population: Paediatric
Setting: Intensive care
Time: <2 min
Items: 8
Score or threshold: ≥9

Format: The instrument records 8 scored items or observations. This site classifies it under episodic assessment, assessment of delirium in children and monitoring for new onset delirium. It is intended for paediatric use in Intensive care. The stated administration time is <2 min. The published result is recorded using ≥9.

Strengths: All paediatric ages; rapid nursing screen
Limitations: Lower specificity in developmental delay

Training and instructions

Using the CAPD and developmental anchor points. Public ICU Delirium resource directory. Open the resource with this tool’s name; versions are listed separately.
CAPD form. Public instrument material checked on 5 September 2026. Follow the source’s version and permission conditions.
CAPD manual or instructions. Public manual or instructions checked on 5 September 2026. Follow the source’s version and permission conditions.

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Tool and original sources

A source for the tool or its access information is linked below. Check the version and current terms before use, copying or adaptation.

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Original and selected diagnostic-accuracy papers

Original paperTraube C, Silver G, Kearney J, Patel A, Atkinson TM, Yoon MJ, et al. Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU*. Critical care medicine. 2014;42(3):656-63. doi: 10.1097/CCM.0b013e3182a66b76. PMID: 24145848.
This is the original published source for CAPD. It reported sensitivity of 94.1% and specificity of 79.2% against an independent DSM-IV clinical assessment.
Open PubMed ↗
Systematic review of diagnostic accuracyDaoud A, Duff JP, Joffe AR, Alberta Sepsis Network. Diagnostic accuracy of delirium diagnosis in pediatric intensive care: a systematic review. Critical care (London, England). 2014;18(5):489. doi: 10.1186/s13054-014-0489-x. PMID: 25672219.
This systematic review synthesised diagnostic-accuracy evidence for CAPD. Tool-specific results included CAP-D sensitivity 91% and specificity 100% (n=50), and revised CAP-D sensitivity 94% and specificity 79% (n=111).
Open PubMed ↗Download article PDF ↓
Article PDF: CC BY. This licence applies to the article PDF and does not grant rights to reproduce the tool.
Selected diagnostic-accuracy studyPaterson RS, Kenardy JA, Dow BL, De Young AC, Pearson K, Aitken LM, et al. Accuracy of delirium assessments in critically ill children: A prospective, observational study during routine care. Australian critical care : official journal of the Confederation of Australian Critical Care Nurses. 2021;34(3):226-234. doi: 10.1016/j.aucc.2020.07.012. PMID: 33909556.
This diagnostic-accuracy study evaluated CAPD in 36-bed mixed paediatric ICU at an Australian tertiary hospital against a DSM-5 clinical assessment. It reported sensitivity of 91.3% and specificity of 75.2% in Critically ill children developmentally aged 6 months to 17 years.
Open PubMed ↗

Multiple DTA studies identifiedCore instrument family

Classification

Episodic assessment Assessment of delirium in children Monitoring for new onset delirium Use in intensive care units

A tool may belong to more than one category. Select a linked category to see other relevant profiles.

Evidence

Diagnostic-accuracy evidenceMultiple DTA studies identified

Reported sensitivity and specificity

Headline metric source

Original/source study · 2014; pmid:24145848

Denominator: 111 patients; 248 paired assessments
Reference standard: Child psychiatrist DSM-IV delirium assessment

94.1%

Sensitivity

79.2%

Specificity

Traube et al. (2014): 248 paired assessments in 111 patients, compared with child psychiatrist DSM-IV assessment. These accuracy estimates use assessments, not 248 separate patients.

Expanded evidence profile

What the broader evidence shows

Interpretation: CAPD is a high-sensitivity observational screen usable across the paediatric age range, including children who cannot complete cognitive testing. Specificity is lower in children with developmental delay and in some ventilated cohorts, so a positive score needs clinical review and developmental context rather than automatic diagnostic labelling.

Evidence snapshots

Original validation (2014): Across 248 paired assessments in 111 children, a score of 9 or more gave 94.1% sensitivity and 79.2% specificity against child-psychiatrist DSM-IV diagnosis.
Mechanically ventilated cohort (2023): Across 837 paired assessments, sensitivity was 81.8% and specificity 44.8%; specificity fell to 16.5% in children with developmental delay.
Paediatric ICU meta-analysis (2024): Seven CAPD studies gave pooled sensitivity 0.95 and specificity 0.81, making CAPD more sensitive but less specific than pCAM-ICU.
Indonesian validation (2025): In 90 children, sensitivity was 92%, specificity 93% and area under the curve 0.96; a later correction changed funding wording only, not the data or conclusions.

These results come from different populations and workflows and should not be averaged or treated as interchangeable.

8 selected PubMed-indexed papers, 2014–2025

2014Original validation study
Traube C, Silver G, Kearney J, Patel A, Atkinson TM, Yoon MJ, et al. Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU. Crit Care Med. 2014;42(3):656-663. doi: 10.1097/CCM.0b013e3182a66b76. PMID: 24145848.
The original validation included 111 children aged from infancy to 21 years and 248 paired CAPD and child-psychiatrist DSM-IV assessments. A threshold of 9 or more gave 94.1% sensitivity and 79.2% specificity; specificity was only 51.2% among children with developmental delay.
PubMed · PMID 24145848 ↗
2020Japanese validation study
Hoshino H, Matsuishi Y, Enomoto Y, Shimojo N, Kido T, Matsuzaki A, et al. The Validity and Reliability of the Japanese Version of the Cornell Assessment of Pediatric Delirium. Pediatr Crit Care Med. 2020;21(5):e267-e273. doi: 10.1097/PCC.0000000000002274. PMID: 32106186.
This Japanese study obtained 92 paired assessments in 41 children and used a DSM-5 reference assessment. At a threshold of 9, sensitivity was 90%, specificity 88% and area under the curve 0.92, although specificity was lower in mechanically ventilated children.
PubMed · PMID 32106186 ↗
2020Developmental-disability study
Kaur S, Silver G, Samuels S, Rosen AH, Weiss M, Mauer EA, et al. Delirium and Developmental Disability: Improving Specificity of a Pediatric Delirium Screen. Pediatr Crit Care Med. 2020;21(5):409-414. doi: 10.1097/PCC.0000000000002248. PMID: 32106184.
This study included 40 children with developmental delay and 94 paired assessments. Combining CAPD 9 or more with fluctuation in RASS across 24 hours improved specificity to 97%, but the result applies to an adapted two-part strategy rather than CAPD alone.
PubMed · PMID 32106184 ↗
2021Routine-care diagnostic-accuracy study
Paterson RS, Kenardy JA, Dow BL, De Young AC, Pearson K, Aitken LM, Long DA. Accuracy of delirium assessments in critically ill children: A prospective, observational study during routine care. Aust Crit Care. 2021;34(3):226-234. doi: 10.1016/j.aucc.2020.07.012. PMID: 33909556.
This prospective Australian PICU study compared routinely delivered CAPD and pCAM-ICU assessments with DSM-5 diagnosis. CAPD sensitivity was 91.3% and specificity 75.2%, supporting good sensitivity in routine care but also a substantial false-positive burden.
PubMed · PMID 33909556 ↗
2021Postoperative diagnostic-accuracy study
Hong H, Guo C, Liu ZH, Wang BJ, Zhou SZ, Mu DL, et al. The diagnostic threshold of Cornell assessment of pediatric delirium in detection of postoperative delirium in pediatric surgical patients. BMC Pediatr. 2021;21(1):87. doi: 10.1186/s12887-021-02538-x. PMID: 33596858.
This single-centre study enrolled 170 children after elective surgery, of whom 23 had delirium by psychiatrist DSM-5 assessment. A CAPD threshold of 9 gave 87% sensitivity, 98% specificity and an area under the curve of 0.911.
PubMed · PMID 33596858 ↗
2023Mechanically ventilated cohort study
Gupta N, Talathi S, Woolley A, Wilson S, Franklin M, Robbins J, et al. Performance of Cornell Assessment of Pediatric Delirium Scale in Mechanically Ventilated Children. J Pediatr Intensive Care. 2023;12(1):24-30. doi: 10.1055/s-0041-1728784. PMID: 36742252.
This mechanically ventilated cohort contributed 837 paired CAPD and DSM-5 assessments. At a threshold of 9, sensitivity was 81.8% and specificity 44.8%; specificity fell to 16.5% among children with developmental delay, demonstrating important overcalling in this subgroup.
PubMed · PMID 36742252 ↗
2024Systematic review and meta-analysis
Rohmah I, Chen YC, Lin CJ, Tsao NH, Chiu HY. Diagnostic accuracy of the pediatric CAM-ICU, pre-school CAM-ICU, Pediatric Anesthesia Emergence Delirium and Cornell Assessment of Pediatric Delirium for detecting delirium in the pediatric intensive care unit: A systematic review and meta-analysis. Intensive Crit Care Nurs. 2024;82:103606. doi: 10.1016/j.iccn.2023.103606. PMID: 38158251.
This meta-analysis included seven CAPD studies and several studies of other paediatric delirium instruments. Pooled CAPD sensitivity was 0.95 and specificity 0.81, indicating greater sensitivity but lower specificity than pCAM-ICU; study and patient characteristics contributed to heterogeneity.
PubMed · PMID 38158251 ↗
2025Indonesian diagnostic-accuracy study
Rohmah I, Lusdiana I, Maulina R, Widodo AF, Chiu HY. Assessment of delirium in Indonesian pediatric intensive care unit: a psychometric evaluation of the Cornell Assessment of Pediatric Delirium. Eur J Pediatr. 2025;184(2):153. doi: 10.1007/s00431-025-05984-2. PMID: 39853464.
This Indonesian PICU study compared CAPD with psychiatrist DSM-5 assessment in 90 children. At a threshold of 9, sensitivity was 92%, specificity 93% and area under the curve 0.96; a linked correction (PMID 40439749) changed the funding statement only and did not alter the methods, results or conclusions.
PubMed · PMID 39853464 ↗

This is a selected evidence overview, not a systematic review. The panel prioritises DSM-based diagnostic studies, subgroup limitations and the recent meta-analysis; all eight main records and the linked correction were checked in PubMed, with citation-network screening in OpenAlex and integrity checks in Scite, on 31 August 2026.

More evidence and citation details

Full name: Cornell Assessment of Pediatric Delirium
Also known as: CAPD, CAP-D
Related profiles: CAP-D pilot
Evidence summary: multi
Diagnostic-accuracy evaluations: 10
Reference standard: DSM-IV (child psychiatrist)
Source-study sample: 111 patients; 248 assessments; 2014 · pmid:24145848; Original/source diagnostic-accuracy sample
Reliability: Inter-rater κ 0.94; α 0.90
Citation: Traube C, Silver G, Kearney J, Patel A, Atkinson TM, Yoon MJ, Halpert S, Augenstein J, Sickles LE, Li C, Greenwald B Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU* Critical care medicine. 2014;42(3):656-63. PMID 24145848

Download RIS ↗ Download BibTeX ↗

Primary validation studies

Distinct primary publications from the current diagnostic-accuracy audit. Reviews and repeated evaluations within one paper are not counted again. Overlapping cohorts have not all been reconciled. Read the counting rules and limitations.

Open 10 identified papers

Traube C, Silver G, Kearney J, Patel A, Atkinson TM, Yoon MJ, Halpert S, Augenstein J, Sickles LE, Li C, Greenwald B (2014). Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU*. Critical care medicine.
Reference category: independent clinical reference.
He S, Wang YL, Zuo ZL (2019). [Clinical application of the Chinese version of Cornell assessment of pediatric delirium: a pilot study]. Zhonghua er ke za zhi = Chinese journal of pediatrics.
Reference category: independent clinical reference.
Hoshino H, Matsuishi Y, Enomoto Y, Shimojo N, Kido T, Matsuzaki A, Matsubara M, Kato H, Hoshino T, Traube C, Silver G, Kawano S, Inoue Y (2020). The Validity and Reliability of the Japanese Version of the Cornell Assessment of Pediatric Delirium. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
Reference category: independent clinical reference.
Hong H, Guo C, Liu ZH, Wang BJ, Zhou SZ, Mu DL, Wang DX (2021). The diagnostic threshold of Cornell assessment of pediatric delirium in detection of postoperative delirium in pediatric surgical patients. BMC pediatrics.
Reference category: independent clinical reference.
Paterson RS, Kenardy JA, Dow BL, De Young AC, Pearson K, Aitken LM, Long DA (2021). Accuracy of delirium assessments in critically ill children: A prospective, observational study during routine care. Australian critical care : official journal of the Confederation of Australian Critical Care Nurses.
Reference category: independent clinical reference.
Fazio PC, Daverio M, Masola M, D'Angelo I, Frison S, Zaggia C, Simeone S, Pucciarelli G, Gregori D, Comoretto R, Amigoni A (2022). Italian Version of the Cornell Assessment of Pediatric Delirium: Evaluation of the Scale Reliability and Ability to Detect Delirium Compared to Pediatric Intensive Care Unit Physicians Clinical Evaluation. Frontiers in pediatrics.
Reference category: independent clinical reference.
Gupta N, Talathi S, Woolley A, Wilson S, Franklin M, Robbins J, Colston C, Hayes L (2023). Performance of Cornell Assessment of Pediatric Delirium Scale in Mechanically Ventilated Children. Journal of pediatric intensive care.
Reference category: independent clinical reference.
Rohmah I, Lusdiana I, Maulina R, Widodo AF, Chiu HY (2025). Assessment of delirium in Indonesian pediatric intensive care unit: a psychometric evaluation of the Cornell Assessment of Pediatric Delirium. European journal of pediatrics.
Reference category: independent clinical reference.
Uyar E, Kutlu NO, Akçay E, Dinç G, Onat M, Koçkuzu E, Meral Y, Traube C (2025). Cornell Assessment of Pediatric Delirium: Turkish translation and validation. The Turkish journal of pediatrics.
Reference category: independent clinical reference.
Chen YC, Foster J, Wang ML, Marks A, Schmied V, Chang KM, Su HG, Tsao NH, Chiu HY (2025). Pediatric Emergence Delirium Following General Anesthesia for Orthopedic Surgery: Psychometric Properties of the Traditional Chinese Version of the Cornell Assessment of Pediatric Delirium. Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses.
Reference category: other comparator or secondary accuracy evidence.

Version: Use the current version supplied by CIBS
Information checked: 2026-07-19

Instrument-specific terms apply. See the access and copyright policy or send a correction.

Base clinical review: 2026-07-29. Instrument description source check: 2026-09-05. Scope and limitations.