Comparison of The confusion assessment method for the intensive care unit (CAM-ICU) with the Intensive Care Delirium Screening Checklist (ICDSC) for delirium in critical care patients gives high agreement rate(s)
Department of Anaesthesiology, Clinical-Experimental Anaesthesiology, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Intensive Care Medicine
(Impact Factor: 7.21).
03/2008; 34(3):431-6. DOI: 10.1007/s00134-007-0920-8
In the intensive care unit (ICU) we assessed the agreement between the delirium ratings of two independent delirium assessment methods: (a) the Confusion Assessment method for the ICU (CAM-ICU); and (b) the Intensive Care Delirium Screening Checklist (ICDSC).
Prospective, descriptive cohort study.
During a 6-month period, 174 patients (mean age 62.4+/-13.0 years) admitted to the ICU after elective surgery or after an emergency were included and assessed with both delirium assessment systems by two trained independent investigators (research person and bedside nurses) during their ICU stay or for up to 7 days after ICU admission.
Patients' clinical characteristics at ICU admission day were documented.
After excluding permanently unconscious patients with <or=-4 on the Richmond Agitation Sedations scale, delirium was identified in 71 of the 174 patients (41%). The patients who were included were tested in 374 paired but researcher-independent ratings of delirium by both scoring methods. The kappa coefficient determined over 7 days of ICU stay was 0.80 (CI 95%: 0.78-0.84; p<0.001), indicating good agreement.
It is concluded from the present investigation that the two scoring methods represent good diagnostic tools with high agreement rates in critical ill ICU patients.
Available from: Mansoor Masjedi
- "It may also prolong the duration of hospital stay and increase the need for nursing care and mortality rate   . Long-lasting untreated delirium could be quite dangerous by leaving long-term cognitive impairment and major psychological sequels for the patients . "
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ABSTRACT: Inappropriate diagnosis and treatment of pain, agitation, and delirium (PAD) in intensive care settings results in poor patient outcomes. We designed and used a protocol for systematic assessment and management of PAD by the nurses to improve clinical intensive care unit (ICU) outcomes.
A total of 201 patients admitted to 2 mixed medical-surgical ICUs were randomly allocated to protocol and control groups. A multidisciplinary team approved the protocol. Pain was assessed by Numerical Rating Scale and Behavioural Pain Scale, agitation by Richmond Agitation Sedation Scale, and delirium by Confusion Assessment Method in ICU. The Persian version of the scales was prepared and tested for validity, reliability, and feasibility in a preliminary study. The patients in the protocol group were managed pharmacologically according to the protocol, whereas those in the control group were managed according to the ICU routine.
The median (interquartile range) for the duration of mechanical ventilation in the protocol and control groups was 19 (9.3-67.8) and 40 (0-217) hours, respectively (P = .038). The median (interquartile range) length of ICU stay was 97 (54.5-189) hours in the protocol group vs 170 (80-408) hours in the control group (P < .001). The mortality rate in the protocol group was significantly reduced from 23.8% to 12.5% (P = .046).
The current randomized trial provided evidence for a substantial reduction in the duration of need to ventilatory support, length of ICU stay, and mortality rates in ICU-admitted patients through protocol-directed management of PAD.
Available from: Matthias David
- "Delirium as a clinical diagnosis was assessed using the confusion assessment method for the ICU (CAM-ICU) [2,4]. The CAM-ICU is a validated examination score to diagnose delirium in mechanically ventilated patients . The CAM-ICU was assessed at day 4 during measurement of AR when sedative medication was temporarily reduced, to reach a RASS score greater than -2. "
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ABSTRACT: Sepsis-associated delirium (SAD) increases morbidity in septic patients and, therefore, factors contributing to SAD should be further characterized. One possible mechanism might be the impairment of cerebrovascular autoregulation (AR) by sepsis, leading to cerebral hypo- or hyperperfusion in these haemodynamically unstable patients. Therefore, the present study investigates the relationship between the incidence of SAD and the status of AR during sepsis.
Cerebral blood flow velocity was measured using transcranial Doppler sonography and was correlated with the invasive arterial blood pressure curve to calculate the index of AR Mx (Mx>0.3 indicates impaired AR). Mx was measured daily during the first 4 days of sepsis. Diagnosis of a SAD was performed using the confusion assessment method for ICU (CAM-ICU) and, furthermore the predominant brain electrical activity in electroencephalogram (EEG) both at day 4 after reduction of sedation to RASS >-2.
30 critically ill adult patients with severe sepsis or septic shock (APACHE II 32 ± 6) were included. AR was impaired at day 1 in 60%, day 2 in 59%, day 3 in 41% and day 4 in 46% of patients; SAD detected by CAM-ICU was present in 76 % of patients. Impaired AR at day 1 was associated with the incidence of SAD at day 4 (p = 0.035).
AR is impaired in the great majority of patients with severe sepsis during the first two days. Impaired AR is associated with SAD, suggesting that dysfunction of AR is one of the trigger mechanisms contributing to the development of SAD.
clinicalTrials.gov ID NCT01029080
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