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.
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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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    • "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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