Reply To: CAR T Neuro Assessment Tools

  • Maritza Salazar Abshire

    August 6, 2018 at 12:04 pm

    Hello All,

    I had the same question several years ago when we were first developing our nursing practice for CAR T cells administration, patient assessment and  documentation  of such  for pediatrics.  Via an interdisciplinary group which included a neurologist, neuropsych, an intensivist, nursing educator, bedside nurse and transplant physicians among others we decided that the CAP-D (Cornell Assessment for Pediatric Delirium) would be the best validated instrument t to utilize for this patient population. Although somewhat subjective, it allows for anyone to administer the test without patient fatigue regarding the exercises or questions that may be asked of them. We also require a daily handwriting sample for those patients who can write. The CAP-D is done at the end of each 12 hour shift and as needed by the bedside nurse. The nurses were educated to alert the provider when they evaluated the patient with a score of 9 or greater.  The CAP-D was integrated into our CAR T flowsheet in Epic as well.  We provided the staff with Education in July of 2017 in preparation for our upcoming CAR T patients.  I include CRS, and the CAP D education in the orientation of my new staff as well as in my Pediatric Oncologic Emergencies Course.

    I know that our intensive care physician secured permission to use the CAP D and incorporate it into our EMR as well. 

    Hope this helps.

    Maritza Salazar-Abshire, MSN, MED, RN, CPON
    Senior Nursing Instructor
    The Children’s Cancer Hospital at The University of Texas MD Anderson Cancer Center
    Houston, Texas
    Original Message:
    Sent: 08-04-2018 11:18 AM
    From: Leticia Valdiviez
    Subject: CAR T Neuro Assessment Tools

    Hi Chris,

    This is a great question. Out side of what the KITE CAR T study uses (and can’t be shared) I have yet to come across anything. Dr. Pulsipher let me know one of our new attending physicians has an interest in this and I will pass along her response to this question. Just emailed her yesterday.

    I also asked our neuropsych team about this and they could not think of a tool that could be administered by just any team member.

    I would be interested in hearing if anyone has a tool.

    Letty Valdiviez, MSN, RN, CPHON
    CAR T Coordinator
    Children’s Hospital Los Angeles

    Original Message:
    Sent: 08-04-2018 09:58 AM
    From: Chris Donaghey
    Subject: CAR T Neuro Assessment Tools

    Hello everyone,

    Does your facility use a validated tool for neuro assessments during CAR T?

    The CARTOX-10 exists, but it has limited pediatric  applicability.

    I haven’t heard of so many tools from other places other than handwriting samples/assessments, identifying people in the room, etc.


    Chris Donaghey, MSN, RN, PCNS-BC, CPN, CPHON
    Clinical Nurse Specialist – Riley Cancer Center
    Riley Hospital for Children at IU Health
    Indianapolis, IN