Reply To: CAR T Neuro Assessment Tools

  • Chris Donaghey

    August 8, 2018 at 1:26 pm

    Thanks to each of you for the responses.

    There’s an article published a couple days ago (very timely for us as we “suit up” soon) that’s going to inform how we assess our kids, a consensus statement from the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Hematopoietic Stem Cell Transplantation (HSCT) Subgroup and the MD Anderson Cancer Center CAR T Cell Therapy- Associated Toxicity (CARTOX) Program.

    The title is “Management guidelines for paediatric patients receiving chimeric antigen receptor T cell therapy,” published in Nature Reviews Clinical Oncology, authored by Mahadeo et al.

    It speaks in kind of both the CAPD and the CARTOX-10.

    As someone who’s new to the game, this was extremely useful and informative for crafting guidelines and resources.

    Chris Donaghey, MSN, RN, PCNS-BC, CPN, CPHON
    Clinical Nurse Specialist – Riley Cancer Center
    Riley Hospital for Children at IU Health
    Indianapolis, IN
    Original Message:
    Sent: 08-08-2018 01:17 PM
    From: Michelle Gillard
    Subject: CAR T Neuro Assessment Tools


    We had similar questions when we started doing CAR.


    PCH chose the psCAM, pCAM, CAM series, along with a bedside screening checklist. We took some of the components from CARTOX, but since it isn’t validated yet and adult-oriented, we haven’t adopted that tool (yet). We do use the handwriting sample component, however. The CAP-d is validated, but for pediatric patients only and in the ICU setting, to my understanding. About half of our patients are young adults, but we do use CAP-d in the PICU, if a patient transfers.

    We get a baseline neuropsych and psychiatry assessment as well. So far, we’ve done very well with these screening tools and the bedside RNs have done a tremendous job of consistent screening.




    Original Message——

    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