Comparison of delirium assessment tools in a mixed intensive care unit

Department of Intensive Care, University Medical Center Utrecht, the Netherlands.
Critical care medicine (Impact Factor: 6.31). 05/2009; 37(6):1881-5. DOI: 10.1097/CCM.0b013e3181a00118
Source: PubMed


Delirium is a frequent problem in the intensive care unit (ICU) associated with poor prognosis. Delirium in the ICU is underdiagnosed by nursing and medical staff. Several detection methods have been developed for use in ICU patients. The aim of this study was to compare the value of three detection methods (the Confusion Assessment Method for the ICU [CAM-ICU], the Intensive Care Delirium Screening Checklist [ICDSC] and the impression of the ICU physician with the diagnosis of a psychiatrist, neurologist, or geriatrician).
Prospective study.
During an 8-month period, 126 patients (mean age 62.4 years, sd 15.0; mean Acute Physiology and Chronic Health Evaluation II score 20.9, sd 7.5) admitted to a 32-bed mixed medical and surgical ICU were studied.
The included patients were assessed independently by trained ICU nurses using either the CAM-ICU or the ICDSC. Furthermore, the ICU physician was asked whether a patient was delirious or not. A psychiatrist, geriatrician, or neurologist serving as reference rater diagnosed delirium using established criteria.
The CAM-ICU showed superior sensitivity and negative predictive value (64% and 83%) compared with the ICDSC (43% and 75%). The ICDSC showed higher specificity and positive predictive value (95% and 82% vs. 88% and 72%). The sensitivity of the physicians view was only 29%.
ICU physicians underdiagnose delirium in the ICU, which underlines the necessity of standard evaluation in all critically ill patients. In our mixed ICU population, the CAM-ICU had a higher sensitivity than the ICDSC.

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Available from: Jozef Kesecioglu, Dec 23, 2013
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    • "Le patient se trouve très rapidement dépendant de traitements de suppléance d'organe (ex : ventilation mécanique) dont l'extrême intensité et la soudaineté de la prise en charge est une véritable catastrophe somatique, mais également psychique [5] [6] [7]. Ainsi, des états de sidération, de régression, de confusion, d'agitation et d'hallucinations sont observés fréquemment chez les patients [8] [9] [10] [11] [12] [13] [14]. Ce contexte rend difficile toute forme de communication et conduisent les professionnels à se cantonner à une pratique objective et technique. "
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    ABSTRACT: In intensive care, the severity of health patient makes communication difficult between the patient and the professional. Our aim is to identify and better understand the experiences of the relationship of care among intensive care professionals.
    L &E cute volution Psychiatrique 01/2015; DOI:10.1016/j.evopsy.2014.12.007 · 0.13 Impact Factor
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    • "The occurrence of delirium is a significant predictor of adverse outcomes such as self-extubation and removal of catheters (Dubois et al., 2001), longer Intensive Care Unit (ICU) and hospital stay (Ely et al., 2001c; Ouimet et al., 2007a; Shehabi et al., 2010), increased costs (Milbrandt et al., 2004), higher six-month and one-year mortality (Ely et al., 2004; Lin et al., 2004; Pisani et al., 2009), and long term cognitive impairment (Girard et al., 2010; Maclullich et al., 2009; van den Boogaard et al., 2012). Delirium is missed by clinical personnel 75% of the time when a formal delirium assessment is not performed using validated instruments (Spronk et al., 2009; Van Eijk et al., 2009). Different available tools have been studied and used in the daily ICU practice such as the Confusion Assessment Method for the ICU (CAM-ICU), Delirium Detection Score, "
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    ABSTRACT: Objectives: To determine the psychometric properties of the Italian version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), a clinical assessment tool to detect delirium among Intensive Care Unit patients. Design: Validation study. Research methodology: Fifty-seven patients admitted to three medical and surgical Intensive Care Units were recruited. During the study interval two trained examiners performed independent delirium assessment by the CAM-ICU for a maximum of four times per patient. Main outcome measures: Interrater reliability and internal consistency of the tool, which were measured using Cohen's kappa and Cronbach's alpha coefficients respectively. Findings: Seventy-two paired evaluations were collected. The 35% of the studied cohort tested positive for delirium. The Italian version of the CAM-ICU demonstrated a substantial interrater reliability (kappa=0.76, p<0.0001) and a very good internal consistency (alpha = 0.87, 95% confidence interval: 0.81-0.91). Conclusion: The Italian CAM-ICU was found to be a viable instrument by which to approach a standardised monitoring of delirium among Italian speaking ICU patients. The use of such tools may facilitate ICU physicians and nurses in detecting delirium, thus improving both quality and safety of care.
    Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses 07/2014; 30(5). DOI:10.1016/j.iccn.2014.05.002
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    • "Despite its frequency and impact, recognition of delirium by ICU-physicians is poor (overall sensitivity 29%)[2]. In order to improve early diagnosis and treatment, the Society of Critical Care Medicine and the American Psychiatric Association recommend daily monitoring of delirium in ICU patients[7,8]. "
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    ABSTRACT: Delirium is an acute disturbance of consciousness and cognition. It is a common disorder in the intensive care unit (ICU) and associated with impaired long-term outcome. Despite its frequency and impact, delirium is poorly recognized by ICU-physicians and -nurses using delirium screening tools. A completely new approach to detect delirium is to use monitoring of physiological alterations. Temperature variability, a measure for temperature regulation, could be an interesting component to monitor delirium, but whether temperature regulation is different during ICU delirium has not yet been investigated. The aim of this study was to investigate whether ICU delirium is related to temperature variability. Furthermore, we investigated whether ICU delirium is related to absolute body temperature. We included patients who experienced both delirium and delirium free days during ICU stay, based on the Confusion Assessment method for the ICU conducted by a research- physician or -nurse, in combination with inspection of medical records. We excluded patients with conditions affecting thermal regulation or therapies affecting body temperature. Daily temperature variability was determined by computing the mean absolute second derivative of the temperature signal. Temperature variability (primary outcome) and absolute body temperature (secondary outcome) were compared between delirium- and non-delirium days with a linear mixed model and adjusted for daily mean Richmond Agitation and Sedation Scale scores and daily maximum Sequential Organ Failure Assessment scores. Temperature variability was increased during delirium-days compared to days without delirium (βunadjusted=0.007, 95% confidence interval (CI)=0.004 to 0.011, p<0.001). Adjustment for confounders did not alter this result (βadjusted=0.005, 95% CI=0.002 to 0.008, p<0.001). Delirium was not associated with absolute body temperature (βunadjusted=-0.03, 95% CI=-0.17 to 0.10, p=0.61). This did not change after adjusting for confounders (βadjusted=-0.03, 95% CI=-0.17 to 0.10, p=0.63). Our study suggests that temperature variability is increased during ICU delirium.
    PLoS ONE 10/2013; 8(10):e78923. DOI:10.1371/journal.pone.0078923 · 3.23 Impact Factor
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