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Research Snapshot Theater: Pharmacology, Adult and Pediatric

Quetiapine Use in Pediatric Delirium: Effects on CAPD Scores and Compliance in a Single-Center Study

Tuesday, March 24, 2026
10:00 AM - 11:00 AM Central Time
Location: Connections Central - RST 08
  • BH

    Brooke Hisrich, MD

    Medical University of South Carolina

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • KS

    Kathleen Sprott, PharmD

    Assistant Professor
    Medical University of South Carolina

    Disclosure information not submitted.

  • JM

    Jenna Mezle, DPT

    Doctor of Physical Therapy
    Medical Univeristy of South Carolina

    Disclosure information not submitted.

  • PS

    Patrick Snyder, MD

    Assistant Professor
    Medical University of South Carolina

    Disclosure information not submitted.

  • AW

    Alice Walz, MD

    Associate Professor
    MUSC Health of Medical University of South Carolina

    Disclosure information not submitted.

Introduction: Acute delirium complicates up to 66% of PICU admissions. While first-line management emphasizes nonpharmacologic strategies, antipsychotic (AP) medications such as quetiapine are often used despite limited evidence in children. As part of a broader quality improvement initiative, this study evaluated Cornell Assessment of Pediatric Delirium (CAPD) scoring compliance surrounding the initiation of quetiapine and examined the impact of AP use on CAPD scores in a single-center PICU.


Methods: This retrospective review included PICU patients from August 2023 to April 2025 who received quetiapine for ≥36 hours for acute delirium. Exclusion criteria included home use of quetiapine, quetiapine prescribed for non-delirium indications, and CAPD assessments performed on ineligible patients. CAPD compliance and scores were reviewed during the 72 hours pre- and post-quetiapine initiation, as well as pre- and post-implementation of a nursing worklist task. Median CAPD scores were analyzed pre- and post-quetiapine initiation. A nursing survey identified perceived barriers to scoring.


Results: A total of 77 unique PICU admissions were included. CAPD scoring compliance improved from 41% before implementation to 57.5% after implementation. Thirty-eight patients (49.4%) had CAPD scores documented both immediately before and 72 hours after quetiapine initiation. The median CAPD score decreased from 21 to 13 after AP initiation with a median percent change of -30.21. Among 47 nurses surveyed, the most reported barrier to CAPD scoring was a lack of education on which patients to assess.


Conclusions: In this single-center descriptive study, CAPD scoring compliance improved following the integration of CAPD scoring into the nursing workflow. Quetiapine use was associated with both a reduction in CAPD scores and the number of patients meeting criteria for acute delirium within 72 hours of initiation. Nursing feedback highlights the need for targeted education on delirium screening, especially for complex populations such as those with developmental delay, traumatic brain injury, or receiving deep sedation. Future directions include unit-wide education, standardization of screening, and the development of best practices for the therapeutic use of AP in targeted populations.