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Azizi Z, O'Regan N, Dukelow T, Bohane T, Harkin E, Donnellan C, Carroll I, Costello M, O'Reilly S, Noonan C, Walsh E, Timmons S. Delirium care in hospitals in Ireland on World Delirium Awareness Day 2023. Ir J Med Sci 2024; 193:2485-2493. [PMID: 38819733 PMCID: PMC11449950 DOI: 10.1007/s11845-024-03692-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/22/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Acute, transient, but sometimes persistent, delirium is characterized by a sharp disruption in attention, consciousness, and cognitive function, and can be caused by many medications and disorders. Delirium occurrence and negative consequences, such as falls and functional decline, can be decreased with multifactorial prevention and timely detection. AIMS To describe current clinical practice in relation to the prevention, assessment, and management of delirium in Irish hospitals; awareness-raising and educational activities; and barriers to good practice. METHODS On World Delirium Awareness Day (15th March 2023), a global survey was conducted of delirium prevalence and care. A senior clinical staff member on each participating ward reported on delirium prevalence at 8AM and 8PM, and on usual ward practice; this data was entered into an online survey by a data collector (typically a clinician from the site, visiting several wards to record data). This study reports data from Irish hospitals. RESULTS In total, 132 wards from 15 hospitals across Ireland participated. Almost 60% of wards used 'personal judgment' for delirium assessment. Having at least one delirium training session in the preceding year was associated with greater use of a formal assessment tool (60.3% versus 18.8%; p < 0.001). Wards reported staff training/education as the main priority to improve care, but 72.7% of wards identified insufficient time to train staff as a key barrier. CONCLUSIONS Clinical practice related to delirium care requires improvement. Awareness raising and staff training require more focus and time in busy clinical settings.
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Affiliation(s)
- Zahra Azizi
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Niamh O'Regan
- Department of Geriatric Medicine, Waterford Integrated Care for Older People, University Hospital Waterford, Waterford, Ireland
| | | | | | | | | | - Ida Carroll
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Maria Costello
- Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway, Ireland
| | | | | | - Erica Walsh
- St Luke's General Hospital Kilkenny, Kilkenny, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
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Geetha J, Babu H, George C. Determinants of delirium in elderly in-patients in a general ward setting in a teaching hospital: A case control study. Ind Psychiatry J 2024; 33:41-47. [PMID: 38853788 PMCID: PMC11155642 DOI: 10.4103/ipj.ipj_16_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/28/2023] [Accepted: 04/15/2023] [Indexed: 06/11/2024] Open
Abstract
Background There is a dearth of research on risk factors of delirium among elderly inpatients in nonintensive low resource settings. Aim To determine the risk factors of delirium in elderly inpatients in a nonintensive care unit setting. Materials and Methods Sixty two elderly patients with delirium (cases) and 62 patients without delirium (controls) were administered a semi-structured proforma with socio-demographic variables and putative predisposing and precipitating risk factors and the Vellore screening instrument for dementia. Results On univariate analysis, factors such as past cognitive impairment, history of nocturnal confusion and delirium, diminished daily living activities, severe medical illness, history of psychiatric illness, presence of dementia, infection, fever above 1000F, abnormal electrolytes abnormal RFT, leukocytes in urine, hypoxia, anticholinergics and benzodiazepines, emergency admission, use of physical restraints, bladder catheterization, more than routine investigations, intensive care unit admission, surgery, and duration of hospital stay more than 10 days were found to be significantly associated with delirium. On multivariate analysis with binary logistic regression, bladder catheterization (odds ratio [OR] = 13.85; confidence interval [CI] = 1.44-133.14), abnormal electrolytes (OR = 5.12; CI = 1.11-23.69), and hypoxia (OR = 75.52; CI = 4.64-1.134E3) were detected to be independently associated with delirium. Conclusion Acute modifiable rather than long-term factors were risk factors for delirium among the elderly. An awareness of modifiable risk factors has the potential of developing targeted interventions for the early mitigation of delirium.
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Affiliation(s)
- Jitha Geetha
- Department of Psychiatry, DR SMCSI Medical College, Karakonam, Trivandrum, Kerala, India
| | - Haritha Babu
- Department of Psychiatry, DR SMCSI Medical College, Karakonam, Trivandrum, Kerala, India
| | - Christina George
- Department of Psychiatry, DR SMCSI Medical College, Karakonam, Trivandrum, Kerala, India
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Yokoyama C, Yoshitnai K, Ogata S, Fukushima S, Matsuda H. Effect of postoperative delirium after cardiovascular surgery on 5-year mortality. JA Clin Rep 2023; 9:66. [PMID: 37831211 PMCID: PMC10575819 DOI: 10.1186/s40981-023-00658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Postoperative delirium is a common complication after cardiovascular surgery. A meta-analysis revealed that postoperative delirium was associated with cognitive decline and dementia, which may affect long-term mortality. However, few studies have reported the association between postoperative delirium after cardiovascular surgery and long-term postoperative mortality. Therefore, we investigated the effect of postoperative delirium on 5-year survival rates of patients who underwent cardiovascular surgery. METHODS We retrospectively reviewed the records of patients who underwent cardiovascular surgery with cardiopulmonary bypass from January 2016 to December 2019. Postoperative delirium was defined as an Intensive Care Delirium Screening score ≥ 3, which might include subclinical delirium. Cox proportional hazards modeling was performed to assess the association between postoperative delirium and mortality. Postoperative mortality in patients with and without delirium was assessed using the Kaplan-Meier method and compared using the log-rank test. RESULTS Postoperative delirium was observed in 562 (31.9%) of 1731 patients. There were more elderly patients, more emergent surgery procedures, longer operative time, and larger transfusion volume in the postoperative delirium group. Cox regression analyses showed that delirium (hazard ratio (HR), 1.501; 95% confidence interval (CI), 1.053-2.140; p = 0.025) and emergent surgery (HR, 3.380; 95% CI, 2.231-5.122; p < 0.001) are significantly associated with 5-year mortality. Among patients who underwent elective surgery, postoperative delirium (HR, 1.987; 95% CI, 1.135-3.481; p = 0.016) is significantly associated with 5-year mortality. Kaplan-Meier survival analysis revealed that patients with postoperative delirium had significantly higher 5-year mortality. CONCLUSIONS Patients with postoperative delirium after cardiovascular surgery have significantly higher 5-year mortality.
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Affiliation(s)
- Chisaki Yokoyama
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, 6-1, Kishibeshinmachi, Suita, Osaka, Japan
| | - Kenji Yoshitnai
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, 6-1, Kishibeshinmachi, Suita, Osaka, Japan.
| | - Soshiro Ogata
- Department of, Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Incidence, Associated Factors, and Outcome of Delirium among Patients Admitted to ICUs in Oman. Crit Care Res Pract 2022; 2022:4692483. [PMID: 36245554 PMCID: PMC9553487 DOI: 10.1155/2022/4692483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/24/2022] [Indexed: 11/26/2022] Open
Abstract
Background The incidence of delirium is high up to 46.3% among patients admitted to ICU. Delirium is linked to negative patient outcomes like increased duration of mechanical ventilation use, prolonged ICU stay, increased mortality rate, and healthcare costs. Despite the importance of delirium and its consequences that are significant, there is a scarcity of studies which explored delirium in Oman. Objectives This study was conducted to assess the incidence of delirium, the association between the selected predisposing factors and precipitating factors with delirium, determine the predicators of delirium, and evaluate its impacts on ICU mortality and ICU length of stay among ICU patients in Oman. Methods A multicenter prospective observational design was used. A total of 153 patients were assessed two-times a day by bedside ICU nurses through the Intensive Care Delirium Screening Checklist (ICDSC). Results The results revealed that the delirium incidence was 26.1%. Regression analysis showed that sepsis, metabolic acidosis, nasogastric tube use, and APACHE II score were independent predictors for delirium among ICU patients in Oman and delirium had significant impacts on ICU length of stay and mortality rate. Conclusion Delirium is common among ICU patients and it is associated with negative consequences. Multidisciplinary prevention strategies should be implemented to identify and treat the modifiable risk factors.
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Junior MM, Kumar A, Kumar P, Gupta P. Assessment of Delirium as an Independent Predictor of Outcome among Critically Ill Patients in Intensive Care Unit: A Prospective Study. Indian J Crit Care Med 2022; 26:676-681. [PMID: 35836643 PMCID: PMC9237160 DOI: 10.5005/jp-journals-10071-23907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mahendran Marriapan Junior
- Department of Anaesthesia and Intensive Care, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Ajay Kumar
- Department of Anaesthesia and Intensive Care, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Pravin Kumar
- Department of Anaesthesia and Intensive Care, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Poonam Gupta
- Department of Anaesthesia and Intensive Care, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
- Poonam Gupta, Department of Anaesthesia and Intensive Care, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India, Phone: +91 9818623450, e-mail:
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Fatehi Hassanabad A, Bahrami N, Novick RJ, Ali IS. Delirium and depression in cardiac surgery: A comprehensive review of risk factors, pathophysiology, and management. J Card Surg 2021; 36:2876-2889. [PMID: 34120376 DOI: 10.1111/jocs.15610] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mental health and wellbeing continue to gain more attention as they are inextricably associated with clinical outcomes, particularly quality of life. Many medical ailments and major surgeries affect patients' mental health, including depression and delirium. AIMS The objective of this manuscript was to comprehensively review and critically examine the literature pertaining to cardiac surgery, depression, and delirium. METHODS This is a narrative review article. We performed our search analysis by using the following key words: "Cardiac Surgery", "Depression", "Delirium", "Clinical outcomes", and "Mental Health". Search analysis was done on MedLine PubMed, accessing indexed peer-reviewed publications. RESULTS Cardiac Surgery is a life-altering intervention indicated to improve morbidity and mortality in patients with cardiovascular diseases. Psychiatric conditions before and after cardiac surgery worsen patient prognosis and increase mortality rate. Specifically, preoperative depression increases postoperative depression and is associated with impaired functional status, slow physical recovery, and an increased readmission rate. DISCUSSION Although the exact pathophysiology between depression and cardiovascular disease (CVD) is unknown, several pathways have been implicated. Unmanaged depression can also lead to other psychological conditions such as delirium. Like depression, the exact association between delirium and CVD is not well understood, but believed to be multifactorial. CONCLUSION Herein, we provide a comprehensive review of the links between depression, delirium, and cardiovascular surgery. We critically examine the current data that pertains to the pathophysiology of these debilitating mental health issues in the context of cardiac surgery. Finally, we summarize the various treatment options available for managing depression and delirium in the cardiac surgery patient population.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Nabila Bahrami
- Department of Medicine, Department of Medicine, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Richard J Novick
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Imtiaz S Ali
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Alberta, Canada
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Abstract
Delirium is the most common psychiatric diagnoses encountered in patients with various medical-surgical illnesses, in all the treatment set-ups, with relatively higher incidence and prevalence in the intensive care units. As delirium is encountered in multiple specialties, it is important to understand the research on this diagnosis. This study aims to assess the research output involving patients of delirium from India. A comprehensive search was undertaken using Medline (PubMed) and other databases. Search words included were “delirium,” “delirious,” “delirium tremens” AND “India.” No filters were used. Internet and hand searches yielded 305 articles. Out of these articles, 151 had the terms “delirium,” “delirious,” “delirium tremens” in the title and these were included for the review. Additionally, 14 articles were included for the review, although these did not have these terms in the title, but delirium was one of the major outcome parameters in these studies. Majority of the papers were original articles (
n
= 81), and these were followed by, case reports (
n
= 58), review articles (
n
= 10), letter to the editor (not as case reports but as a communication;
n
= 13), editorials (
n
= 2) and one clinical practice guideline. Most of the original papers have either focused on epidemiology (incidence, prevalence, outcome, etc.), symptom profile, with occasional studies focusing on effectiveness of various pharmacological interventions. There is a dearth of research in the field of delirium from India. There is a lack of studies on biomarkers, evaluation of nonpharmacological interventions, and evaluation of prevention strategies. It is the need of the hour to carry out more studies to further our understanding of delirium in the Indian context.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjana Kathiravan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Devakshi Dua
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Amirajam Z, Asadi-Noran E, Molaei B, Adiban V, Heidarzadeh M, Hassanpour-Darghah M. Psychometric Properties of Nursing Delirium Screening Scale in Patients Admitted to Intensive Care Units. Indian J Crit Care Med 2021; 25:680-684. [PMID: 34316149 PMCID: PMC8286400 DOI: 10.5005/jp-journals-10071-23853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Nursing Delirium Screening Scale (Nu-DESC) is a new instrument for determining delirium by nurses. The study aimed to investigate the psychometric properties of Nu-DESC and determined the sensitivity and specificity of it. Methods Two evaluators assessed delirium by Nu-DESC in nonintubated patients admitted to intensive care unit (ICU) wards of Ardabil educational and medical centers. For determining psychometric properties of the instrument, the methods of determining content validity, structural validity, criterion validity (the DSM-5 criteria was used as a standard tool), internal consistency, and inter-rater reliability were used. Results Ninety-six participants were assessed two times using the Nu-DESC. The mean age of the participants was 58.84, and 51 (53.1%) of them were male. Due to the high correlation of the Nu-DESC with the study criterion (DSM-5), the criterion validity of the instrument is confirmed. By using DSM-5 instrument, the cutoff score of 2 shows the best sensitivity and specificity. The kappa and alpha coefficients were obtained as r = 0.96 and α = 0.86, which indicate a good agreement between the evaluators and acceptable consistency. Conclusion Nu-DESC can be used as an efficient and reliable instrument by nurses in the ICU. It was also found that taking medical history can help nurses to better interpret the Nu-DESC score at diagnosing delirium. How to cite this article Amirajam Z, Noran EA, Molaei B, Adiban V, Heidarzadeh M, Darghah MH. Psychometric Properties of Nursing Delirium Screening Scale in Patients Admitted to Intensive Care Units. Indian J Crit Care Med 2021;25(6):680–684.
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Affiliation(s)
- Zohreh Amirajam
- Department of Critical Care Nursing, Nursing and Midwifery School, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Elham Asadi-Noran
- Department of Critical Care Nursing, Imam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Behnam Molaei
- Department of Nursing, Nursing and Midwifery School, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Vahid Adiban
- Department of Anesthesiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mehdi Heidarzadeh
- Department of Medical-Surgical Nursing, Nursing and Midwifery School, Ardabil University of Medical Sciences, Ardabil, Iran
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Fuchs S, Bode L, Ernst J, Marquetand J, von Känel R, Böttger S. Delirium in elderly patients: Prospective prevalence across hospital services. Gen Hosp Psychiatry 2020; 67:19-25. [PMID: 32911278 DOI: 10.1016/j.genhosppsych.2020.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 08/15/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study aimed to determine the 1-year prevalence of delirium and the impact of hospitalization characteristics on delirium across 34 services. METHODS In this prospective cohort study of elderly in-patients (>65 years, N = 10,261), delirium was determined with the Delirium Observation Screening Scale (DOS) and the Intensive Care Delirium Screening Checklist (ICDSC) in a single sample over one year. We calculated univariate and multiple logistic regression analyses to understand the power of association between delirium, 34 services, sociodemographic, and admission/discharge factors. RESULTS The prevalence of delirium across all included services was 32%. The odds of developing delirium was highest for intensive care units (ICU, 83.3%, OR 12.34), high for intermediate care units (IMC, 39.8%, OR 1.42) and medical services (34.2%, OR 1.19), and lower for surgical services (28.7%, OR 0.72). Compared with patients without delirium, patients with delirium were older (76.6 vs. 75 years), hospitalized twice as long (14.3 vs. 7.7 days), more commonly had pre-existent dementia (OR 11.98), and were more likely to die in-hospital (OR 24.20) and be admitted from (OR 2.75-2.97) and discharged to institutions (OR 1.66-3.97). CONCLUSION This study elaborated on the 1-year prevalence of delirium across 34 services and confirmed previous pooled findings in addition to providing new insights regarding the course of hospitalization in elderly patients.
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Affiliation(s)
- Simon Fuchs
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
| | - Leonie Bode
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
| | - Jutta Ernst
- Institute of Nursing Science, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Justus Marquetand
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Tübingen, Germany.
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
| | - Sönke Böttger
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
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Chen TJ, Chung YW, Chang HCR, Chen PY, Wu CR, Hsieh SH, Chiu HY. Diagnostic accuracy of the CAM-ICU and ICDSC in detecting intensive care unit delirium: A bivariate meta-analysis. Int J Nurs Stud 2020; 113:103782. [PMID: 33120134 DOI: 10.1016/j.ijnurstu.2020.103782] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/21/2020] [Accepted: 09/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Delirium is a critical and highly prevalent problem among critically ill patients. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the most recommended assessment tools for detecting intensive care unit (ICU) delirium. OBJECTIVES To synthesize the current evidence and compared the diagnostic accuracy of the two tools in the detection of delirium in adults in ICUs. DESIGN Systematic review and meta-analysis. DATA SOURCE A comprehensive search of the following electronic databases was performed using PubMed, Embase, CINAHL and ProQuest Dissertations and Theses A&I. The date range searched was from database inception to April 26, 2019. REVIEW METHODS Two researchers independently identified articles, systematically abstracted data and evaluated the sensitivity and specificity of the CAM-ICU or the ICDSC against standard references. Bivariate diagnostic statistical analysis with a random-effects model was performed to summarize the pooled sensitivity and specificity of the two tools. RESULTS In total, 29 CAM-ICU and 12 ICDSC studies were identified. The pooled sensitivity was 0.84 and 0.83 and pooled specificity was 0.95 and 0.87 for the CAM-ICU and the ICDSC, respectively. The CAM-ICU had higher summary specificity than the ICDSC did (p = 0.04). The percentage of hypoactive delirium, ICU type, use of mechanical ventilation, number of participants, and female percentage moderated the accuracy of the tools. Most of the domains of patient selection, index test, reference standards, and flow and timing were rated as having a low or unclear risk of bias. CONCLUSIONS Although both the CAM-ICU and the ICDSC are accurate assessment tools for screening delirium in critically ill patients, the CAM-ICU is superior in ruling out patients without ICU delirium and detecting delirium in patients in the medical ICU and those receiving mechanical ventilation. Further investigations are warranted to validate our findings. The study protocol is registered at PROSPERO (CRD42020133544).
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Affiliation(s)
- Ting-Jhen Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Yi-Wei Chung
- Department of Cardiology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Hui-Chen Rita Chang
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia; Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Pin-Yuan Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Neurosurgical Department, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chia-Rung Wu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Shu-Hua Hsieh
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Nacul FE, Paul N, Spies CD, Sechting H, Hecht T, Dullinger JS, Piper SK, Luetz A, Balzer FS, Wernecke KD, Sa AK, Barros Ferreira da Costa C, Eymold L, Chenitir C, Weiss B. Influence of Sedation Level and Ventilation Status on the Diagnostic Validity of Delirium Screening Tools in the ICU-An International, Prospective, Bi-Center Observational Study (IDeAS). ACTA ACUST UNITED AC 2020; 56:medicina56080411. [PMID: 32823781 PMCID: PMC7466203 DOI: 10.3390/medicina56080411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 12/02/2022]
Abstract
Background and objectives: The use of delirium screening instruments (DSIs) is recommended in critical care practice for a timely detection of delirium. We hypothesize that the patient-related factors “level of sedation” and “mechanical ventilation” impact test validity of DSIs. Materials and Methods: This is a prospective, bi-center observational study (clinicaltrials.gov: NCT01720914). Critically ill patients were screened for delirium daily for up to seven days after enrollment using the Nursing Delirium Screening Scale (Nu-DESC), Intensive Care Delirium Screening Checklist (ICDSC), and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Reference standard for delirium diagnosis was the neuropsychiatric examination using the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Immediately before delirium assessment, ventilation status and sedation levels were documented. Results: 160 patients were enrolled and 151 patients went into final analysis. Delirium incidence was 23.2%. Nu-DESC showed a sensitivity and specificity of 88.5%, a positive predictive value (PPV) of 71.9%, and a negative predictive value (NPV) of 95.8%. ICDSC had a sensitivity of 62.5%, a specificity of 92.4%, a PPV of 71.4%, and a NPV of 89.0%. CAM-ICU showed a sensitivity of 75.0%, a specificity of 94.7%, a PPV of 85.7%, and a NPV of 90.0%. For Nu-DESC and ICDSC, test validity was significantly better for non-sedated patients (Richmond Agitation Sedation Scale (RASS) 0/−1), whereas test validity for CAM-ICU in a severity scale version showed no significant differences for different sedation levels. No DSI showed a significant difference in test validity between noninvasively and invasively ventilated patients. Conclusions: Test validities of DSIs were comparable to previous studies. The observational scores ICDSC and Nu-DESC showed a significantly better performance in awake and drowsy patients (RASS 0/−1) when compared with other sedation levels. Physicians should refrain from sedation whenever possible to avoid suboptimal performance of DSIs.
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Affiliation(s)
- Flavio E. Nacul
- Surgical Critical Care Medicine, Hospital Pro-Cardiaco, Rio de Janeiro, RJ 22280-003, Brazil; (F.E.N.); (A.K.S.); (C.B.F.d.C.)
| | - Nicolas Paul
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (N.P.); (C.D.S.); (H.S.); (T.H.); (J.S.D.); (A.L.); (F.S.B.); (L.E.); (C.C.)
| | - Claudia D. Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (N.P.); (C.D.S.); (H.S.); (T.H.); (J.S.D.); (A.L.); (F.S.B.); (L.E.); (C.C.)
| | - Henriette Sechting
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (N.P.); (C.D.S.); (H.S.); (T.H.); (J.S.D.); (A.L.); (F.S.B.); (L.E.); (C.C.)
| | - Thomas Hecht
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (N.P.); (C.D.S.); (H.S.); (T.H.); (J.S.D.); (A.L.); (F.S.B.); (L.E.); (C.C.)
| | - Jörn S. Dullinger
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (N.P.); (C.D.S.); (H.S.); (T.H.); (J.S.D.); (A.L.); (F.S.B.); (L.E.); (C.C.)
| | - Sophie K. Piper
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (S.K.P.); (K.-D.W.)
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
| | - Alawi Luetz
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (N.P.); (C.D.S.); (H.S.); (T.H.); (J.S.D.); (A.L.); (F.S.B.); (L.E.); (C.C.)
- Department of Healthcare Management, Technische Universität Berlin, 10623 Berlin, Germany
| | - Felix S. Balzer
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (N.P.); (C.D.S.); (H.S.); (T.H.); (J.S.D.); (A.L.); (F.S.B.); (L.E.); (C.C.)
| | - Klaus-Dieter Wernecke
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (S.K.P.); (K.-D.W.)
| | - Anna Karinina Sa
- Surgical Critical Care Medicine, Hospital Pro-Cardiaco, Rio de Janeiro, RJ 22280-003, Brazil; (F.E.N.); (A.K.S.); (C.B.F.d.C.)
| | | | - Lisa Eymold
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (N.P.); (C.D.S.); (H.S.); (T.H.); (J.S.D.); (A.L.); (F.S.B.); (L.E.); (C.C.)
| | - Chokri Chenitir
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (N.P.); (C.D.S.); (H.S.); (T.H.); (J.S.D.); (A.L.); (F.S.B.); (L.E.); (C.C.)
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (N.P.); (C.D.S.); (H.S.); (T.H.); (J.S.D.); (A.L.); (F.S.B.); (L.E.); (C.C.)
- Correspondence: ; Tel.: +49-30-450-631-027
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Detroyer E, Timmermans A, Segers D, Meyfroidt G, Dubois J, Van Assche A, Joosten E, Milisen K. Psychometric properties of the intensive care delirium screening checklist when used by bedside nurses in clinical practice: a prospective descriptive study. BMC Nurs 2020; 19:21. [PMID: 32308558 PMCID: PMC7149913 DOI: 10.1186/s12912-020-00415-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/30/2020] [Indexed: 01/11/2023] Open
Abstract
Background The Intensive Care Delirium Screening Checklist (ICDSC) demonstrates good psychometric characteristics in research settings. However, evidence about these characteristics in pragmatic ICU settings is inconsistent. This study evaluated psychometric properties and user-friendliness of the ICDSC when administered by ICU nurses in daily practice. Methods This prospective study included 77 patients from a surgical intensive care unit. To examine the psychometric characteristics, the scores on the ICDSC (performed by bedside nurses) were compared with the scores on the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) (performed by researchers as gold standard). The user-friendliness was evaluated by 34 ICU nurses with a 20-item questionnaire. Results The ICDSC had an area under the curve of 0.843. It showed a good diagnostic accuracy with a sensitivity of 81.0%, a specificity of 87.7%, and a 53.1% positive and 96.4% negative predictive value. The overall Cronbach’s alpha coefficient for all ICDSC scores was high (0.839). Overall, ICU nurses experienced the ICDSC as easy-to-use. The scale was usable in most surgical ICU patients. Yet, some nurses (11.8%) had problems to score the items ‘inappropriate speech’ and ‘symptom fluctuation’ in intubated patients. Conclusions The ICDSC is a valid and user-friendly tool for delirium screening in daily ICU nursing practice. Yet, some problems were reported in intubated patients. Therefore, validation studies with specific focus on intubated patients are needed.
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Affiliation(s)
- Elke Detroyer
- 1Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 - PB 7001/4, B-3000 Leuven, Belgium.,2Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
| | - Annick Timmermans
- 1Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 - PB 7001/4, B-3000 Leuven, Belgium.,3Department of Anesthesiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Dana Segers
- 1Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 - PB 7001/4, B-3000 Leuven, Belgium.,4Department of Intensive Care, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Geert Meyfroidt
- 5Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Jasperina Dubois
- 3Department of Anesthesiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Aimé Van Assche
- 3Department of Anesthesiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Etienne Joosten
- 2Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
| | - Koen Milisen
- 1Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 - PB 7001/4, B-3000 Leuven, Belgium.,2Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
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Al-Qadheeb NS, Nazer LH, Aisa TM, Osman HO, Rugaan AS, Alzahrani AS, Ghonimat IM, Mohammed AM, Maghrabi K, Alrowaished AA, Hussein NH, Maslamani YA, Falatah S, Skrobik Y. Arabic intensive care delirium screening checklist's validity and reliability: A multicenter study. J Crit Care 2019; 54:170-174. [PMID: 31476652 DOI: 10.1016/j.jcrc.2019.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/19/2019] [Accepted: 08/25/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To develop an Arabic version of Intensive Care Delirium Screening Checklist (ICDSC) and assess its validity and reliability among critically ill patients. MATERIALS AND METHODS Multicentered study of convenience sample of adult ICU patients. Arabic translation was performed with rigorous back-to-back translation methods. Concurrent validity was established by calculating the sensitivity and specificity of two examiner assessments compared to a psychiatric evaluation. Kappa coefficients describe interrater reliability, whereas Cronbach α and composite reliability depict internal consistency. RESULTS Three hundred critically ill patients were enrolled. Of these, validity testing was assessed in 180 patients. ICDSC screening was positive for delirium in 11% of enrolled patients. The area under the receiver operator characteristic (ROC) curve is 0.9413, with predicted sensitivity 70% (95% confidence interval [CI]: 60-81%) and specificity 99% (95% CI: 98-100%). The Arabic ICDSC showed acceptable internal consistency (Cronbach α = 0.63 and composite reliability = 0.64). Interrater agreement was excellent (Kappa coefficient [ҡ] = 0.85). CONCLUSIONS Arabic ICDSC is a valid and reliable delirium-screening tool among Arabic-speaking ICU population. Future studies could address whether these findings are generalizable to a higher proportion of mechanically ventilated patients, and address acceptability and reliability in other Arabic language critical care settings.
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Affiliation(s)
- Nada S Al-Qadheeb
- Department of Critical Care, Hafer Albatin Central Hospital, Hafer Albatin, Saudi Arabia.
| | - Lama H Nazer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Tharwat M Aisa
- Department of Critical Care, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Hassan O Osman
- Department of Critical Care, Hafer Albatin Central Hospital, Hafer Albatin, Saudi Arabia
| | - Asia S Rugaan
- Department of Critical Care, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Ahmad S Alzahrani
- Department of Psychiatry, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Iyad M Ghonimat
- Department of Nursing, King Hussein Cancer Center, Amman, Jordan
| | - Alaaldin M Mohammed
- Department of Critical Care, Hafer Albatin Central Hospital, Hafer Albatin, Saudi Arabia
| | - Khalid Maghrabi
- Department of Critical Care, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Abdulellah A Alrowaished
- Department of Psychiatry, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Najah H Hussein
- Department of Nursing, King Hussein Cancer Center, Amman, Jordan
| | - Yahya A Maslamani
- Department of Critical Care, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Sawsan Falatah
- Department of Nursing, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Yoanna Skrobik
- McGill University, Department of Medicine, Regroupement de Soins Critiques Respiratoires, Réseau de Santé Respiratoire FRQS, Montreal, QC, Canada
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14
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Abstract
Delirium is an acute and transient brain dysfunction that is characterized by disturbances in consciousness, affecting both its content (i.e., attention) and level (i.e., arousal). It affects as many as 50% of those admitted to an intensive care unit (ICU). Once believed to be an inconsequential outcome of critical illness, it is now recognized that delirium is harmful in both the short- and long-term. Despite occurring frequently in critically ill patients, delirium often goes unrecognized. Well-validated delirium screening tools, designed for use in the ICU, should be used to reliably detect delirium. The first step in delirium treatment is to identify and address potentially modifiable risk factors. Multiple trials have shown that benzodiazepines are a risk factor for delirium in a dose-dependent manner. Sedation with nonbenzodiazepine-based strategies are an effective means by which to reduce delirium. Nonpharmacologic strategies such as those which seek to reduce sensory impairment, sleep deprivation, and immobility are effective. Pharmacologic treatment with antipsychotics, though commonly used, is not supported by findings from placebo-controlled trials. Recent data support from multiple trials support the use of the "ABCDEF bundle" as a means by which to reduce delirium.
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Affiliation(s)
- Nathan E Brummel
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Timothy D Girard
- Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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15
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Jayaswal AK, Sampath H, Soohinda G, Dutta S. Delirium in medical intensive care units: Incidence, subtypes, risk factors, and outcome. Indian J Psychiatry 2019; 61:352-358. [PMID: 31391638 PMCID: PMC6657559 DOI: 10.4103/psychiatry.indianjpsychiatry_583_18] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Delirium is a frequent yet underdiagnosed neuropsychiatric condition encountered in intensive care units (ICUs). Being both a preventable and potentially reversible process associated with significant morbidity and mortality, understanding risk factors that predispose and precipitate delirium in any given patient are critical in ICUs. AIMS AND OBJECTIVES The aim of this study is to evaluate the incidence, motor subtypes, risk factors, and clinical outcome of delirium in the medical ICU. MATERIALS AND METHODS We used a prospective study design on a cohort of consecutive medical ICU admissions of a tertiary care teaching hospital. The Confusion Assessment Method-ICU and Richmond Agitation Sedation Scale were used to diagnose and motor subtype delirium, respectively, along with a checklist to assess risk factors. RESULTS Of the 280 ICU admissions, 88 (31.4%) developed delirium. Hypoactive delirium was the most common motor subtype (55.7%). The detection rate of delirium was 12.5% (lowest for hypoactive delirium at 2.04%). Age, gender, and years of education did not significantly predict delirium (all P > 0.05). Tobacco use, chronic liver disease, and past episodes of delirium significantly predisposed, while mechanical ventilation, hypoxia, fever, raised levels of bilirubin and creatinine, and benzodiazepine administration significantly precipitated ICU delirium. Delirium was significantly associated with longer ICU stay (t = 4.23, P = 0.000) and 1-month postdischarge mortality (χ 2 = 6.867, P = 0.009). CONCLUSION Detection of delirium is challenging, especially in ICU patients on mechanical ventilation and hypoactive delirium. Screening and monitoring for predisposing and precipitating risk factors can greatly improve the odds of detection and intervention as ICU delirium is associated with significant morbidity and mortality.
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Affiliation(s)
| | - Harshavardhan Sampath
- Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Sikkim, India
| | - Geeta Soohinda
- Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Sikkim, India
| | - Sanjiba Dutta
- Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Sikkim, India
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Age is the Most Significantly Associated Risk Factor With the Development of Delirium in Patients Hospitalized for More Than Five Days in Surgical Wards. Ann Surg 2018. [DOI: 10.1097/sla.0000000000002347] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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17
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Gélinas C, Bérubé M, Chevrier A, Pun BT, Ely EW, Skrobik Y, Barr J. Delirium Assessment Tools for Use in Critically Ill Adults: A Psychometric Analysis and Systematic Review. Crit Care Nurse 2018; 38:38-49. [PMID: 29437077 DOI: 10.4037/ccn2018633] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delirium is highly prevalent in critically ill patients. Its detection with valid tools is crucial. OBJECTIVE To analyze the development and psychometric properties of delirium assessment tools for critically ill adults. METHODS Databases were searched to identify relevant studies. Inclusion criteria were English language, publication before January 2015, 30 or more patients, and patient population of critically ill adults (>18 years old). Search terms were delirium, scales, critically ill patients, adult, validity, and reliability. Thirty-six manuscripts were identified, encompassing 5 delirium assessment tools (Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), Cognitive Test for Delirium, Delirium Detection Score, Intensive Care Delirium Screening Checklist (ICDSC), and Nursing Delirium Screening Scale). Two independent reviewers analyzed the psychometric properties of these tools by using a standardized scoring system (range, 0-20) to assess the tool development process, reliability, validity, feasibility, and implementation of each tool. RESULTS Psychometric properties were very good for the CAM-ICU (19.6) and the ICDSC (19.2), moderate for the Nursing Delirium Screening Scale (13.6), low for the Delirium Detection Score (11.2), and very low for the Cognitive Test for Delirium (8.2). CONCLUSIONS The results indicate that the CAM-ICU and the ICDSC are the most valid and reliable delirium assessment tools for critically ill adults. Additional studies are needed to further validate these tools in critically ill patients with neurological disorders and those at various levels of sedation or consciousness.
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Affiliation(s)
- Céline Gélinas
- Céline Gélinas is associate professor at Ingram School of Nursing, McGill University, Montreal, Quebec, Canada, and is a researcher at the Centre for Nursing Research of the Jewish General Hospital, Montreal, Quebec, Canada.
- Mélanie Bérubé is the trauma program coordinator and research coordinator for the Department of Nursing at the Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada. She is pursuing doctorate studies at Ingram School of Nursing, McGill University.
- Annie Chevrier is assistant director of the Bachelor of Nursing program and is a faculty lecturer in the undergraduate and graduate programs of Ingram School of Nursing, McGill University. She is a clinical associate for the medical mission and steering committee for diabetes care at the McGill University Health Centre.
- Brenda T. Pun is an advanced practice nurse at Vanderbilt University Medical Center, Nashville, Tennessee. She is affiliated with the Geriatric Research Education and Clinical Center of the Veterans Affairs Tennessee Valley Healthcare System.
- E. Wesley Ely is a professor of medicine at Vanderbilt University School of Medicine, Nashville, Tennessee, and Associate Director of Research for the Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC).
- Yoanna Skrobik is an intensive care specialist at McGill University, Montreal, Quebec, Canada.
- Juliana Barr is an associate professor of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, and a staff anesthesiologist and intensivist, VA Palo Alto Health Care System, Palo Alto, California.
| | - Mélanie Bérubé
- Céline Gélinas is associate professor at Ingram School of Nursing, McGill University, Montreal, Quebec, Canada, and is a researcher at the Centre for Nursing Research of the Jewish General Hospital, Montreal, Quebec, Canada
- Mélanie Bérubé is the trauma program coordinator and research coordinator for the Department of Nursing at the Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada. She is pursuing doctorate studies at Ingram School of Nursing, McGill University
- Annie Chevrier is assistant director of the Bachelor of Nursing program and is a faculty lecturer in the undergraduate and graduate programs of Ingram School of Nursing, McGill University. She is a clinical associate for the medical mission and steering committee for diabetes care at the McGill University Health Centre
- Brenda T. Pun is an advanced practice nurse at Vanderbilt University Medical Center, Nashville, Tennessee. She is affiliated with the Geriatric Research Education and Clinical Center of the Veterans Affairs Tennessee Valley Healthcare System
- E. Wesley Ely is a professor of medicine at Vanderbilt University School of Medicine, Nashville, Tennessee, and Associate Director of Research for the Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC)
- Yoanna Skrobik is an intensive care specialist at McGill University, Montreal, Quebec, Canada
- Juliana Barr is an associate professor of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, and a staff anesthesiologist and intensivist, VA Palo Alto Health Care System, Palo Alto, California
| | - Annie Chevrier
- Céline Gélinas is associate professor at Ingram School of Nursing, McGill University, Montreal, Quebec, Canada, and is a researcher at the Centre for Nursing Research of the Jewish General Hospital, Montreal, Quebec, Canada
- Mélanie Bérubé is the trauma program coordinator and research coordinator for the Department of Nursing at the Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada. She is pursuing doctorate studies at Ingram School of Nursing, McGill University
- Annie Chevrier is assistant director of the Bachelor of Nursing program and is a faculty lecturer in the undergraduate and graduate programs of Ingram School of Nursing, McGill University. She is a clinical associate for the medical mission and steering committee for diabetes care at the McGill University Health Centre
- Brenda T. Pun is an advanced practice nurse at Vanderbilt University Medical Center, Nashville, Tennessee. She is affiliated with the Geriatric Research Education and Clinical Center of the Veterans Affairs Tennessee Valley Healthcare System
- E. Wesley Ely is a professor of medicine at Vanderbilt University School of Medicine, Nashville, Tennessee, and Associate Director of Research for the Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC)
- Yoanna Skrobik is an intensive care specialist at McGill University, Montreal, Quebec, Canada
- Juliana Barr is an associate professor of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, and a staff anesthesiologist and intensivist, VA Palo Alto Health Care System, Palo Alto, California
| | - Brenda T Pun
- Céline Gélinas is associate professor at Ingram School of Nursing, McGill University, Montreal, Quebec, Canada, and is a researcher at the Centre for Nursing Research of the Jewish General Hospital, Montreal, Quebec, Canada
- Mélanie Bérubé is the trauma program coordinator and research coordinator for the Department of Nursing at the Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada. She is pursuing doctorate studies at Ingram School of Nursing, McGill University
- Annie Chevrier is assistant director of the Bachelor of Nursing program and is a faculty lecturer in the undergraduate and graduate programs of Ingram School of Nursing, McGill University. She is a clinical associate for the medical mission and steering committee for diabetes care at the McGill University Health Centre
- Brenda T. Pun is an advanced practice nurse at Vanderbilt University Medical Center, Nashville, Tennessee. She is affiliated with the Geriatric Research Education and Clinical Center of the Veterans Affairs Tennessee Valley Healthcare System
- E. Wesley Ely is a professor of medicine at Vanderbilt University School of Medicine, Nashville, Tennessee, and Associate Director of Research for the Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC)
- Yoanna Skrobik is an intensive care specialist at McGill University, Montreal, Quebec, Canada
- Juliana Barr is an associate professor of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, and a staff anesthesiologist and intensivist, VA Palo Alto Health Care System, Palo Alto, California
| | - E Wesley Ely
- Céline Gélinas is associate professor at Ingram School of Nursing, McGill University, Montreal, Quebec, Canada, and is a researcher at the Centre for Nursing Research of the Jewish General Hospital, Montreal, Quebec, Canada
- Mélanie Bérubé is the trauma program coordinator and research coordinator for the Department of Nursing at the Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada. She is pursuing doctorate studies at Ingram School of Nursing, McGill University
- Annie Chevrier is assistant director of the Bachelor of Nursing program and is a faculty lecturer in the undergraduate and graduate programs of Ingram School of Nursing, McGill University. She is a clinical associate for the medical mission and steering committee for diabetes care at the McGill University Health Centre
- Brenda T. Pun is an advanced practice nurse at Vanderbilt University Medical Center, Nashville, Tennessee. She is affiliated with the Geriatric Research Education and Clinical Center of the Veterans Affairs Tennessee Valley Healthcare System
- E. Wesley Ely is a professor of medicine at Vanderbilt University School of Medicine, Nashville, Tennessee, and Associate Director of Research for the Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC)
- Yoanna Skrobik is an intensive care specialist at McGill University, Montreal, Quebec, Canada
- Juliana Barr is an associate professor of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, and a staff anesthesiologist and intensivist, VA Palo Alto Health Care System, Palo Alto, California
| | - Yoanna Skrobik
- Céline Gélinas is associate professor at Ingram School of Nursing, McGill University, Montreal, Quebec, Canada, and is a researcher at the Centre for Nursing Research of the Jewish General Hospital, Montreal, Quebec, Canada
- Mélanie Bérubé is the trauma program coordinator and research coordinator for the Department of Nursing at the Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada. She is pursuing doctorate studies at Ingram School of Nursing, McGill University
- Annie Chevrier is assistant director of the Bachelor of Nursing program and is a faculty lecturer in the undergraduate and graduate programs of Ingram School of Nursing, McGill University. She is a clinical associate for the medical mission and steering committee for diabetes care at the McGill University Health Centre
- Brenda T. Pun is an advanced practice nurse at Vanderbilt University Medical Center, Nashville, Tennessee. She is affiliated with the Geriatric Research Education and Clinical Center of the Veterans Affairs Tennessee Valley Healthcare System
- E. Wesley Ely is a professor of medicine at Vanderbilt University School of Medicine, Nashville, Tennessee, and Associate Director of Research for the Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC)
- Yoanna Skrobik is an intensive care specialist at McGill University, Montreal, Quebec, Canada
- Juliana Barr is an associate professor of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, and a staff anesthesiologist and intensivist, VA Palo Alto Health Care System, Palo Alto, California
| | - Juliana Barr
- Céline Gélinas is associate professor at Ingram School of Nursing, McGill University, Montreal, Quebec, Canada, and is a researcher at the Centre for Nursing Research of the Jewish General Hospital, Montreal, Quebec, Canada
- Mélanie Bérubé is the trauma program coordinator and research coordinator for the Department of Nursing at the Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada. She is pursuing doctorate studies at Ingram School of Nursing, McGill University
- Annie Chevrier is assistant director of the Bachelor of Nursing program and is a faculty lecturer in the undergraduate and graduate programs of Ingram School of Nursing, McGill University. She is a clinical associate for the medical mission and steering committee for diabetes care at the McGill University Health Centre
- Brenda T. Pun is an advanced practice nurse at Vanderbilt University Medical Center, Nashville, Tennessee. She is affiliated with the Geriatric Research Education and Clinical Center of the Veterans Affairs Tennessee Valley Healthcare System
- E. Wesley Ely is a professor of medicine at Vanderbilt University School of Medicine, Nashville, Tennessee, and Associate Director of Research for the Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC)
- Yoanna Skrobik is an intensive care specialist at McGill University, Montreal, Quebec, Canada
- Juliana Barr is an associate professor of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, and a staff anesthesiologist and intensivist, VA Palo Alto Health Care System, Palo Alto, California
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Delirium in the intensive care setting: A reevaluation of the validity of the CAM-ICU and ICDSC versus the DSM-IV-TR in determining a diagnosis of delirium as part of the daily clinical routine. Palliat Support Care 2017; 15:675-683. [PMID: 28173895 DOI: 10.1017/s1478951516001176] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the intensive care setting, delirium is a common occurrence that comes with subsequent adversities. Therefore, several instruments have been developed to screen for and detect delirium. Their validity and psychometric properties, however, remain controversial. METHOD In this prospective cohort study, the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) were evaluated versus the DSM-IV-TR in the diagnosis of delirium with respect to their validity and psychometric properties. RESULTS Out of some 289 patients, 210 with matching CAM-ICU, ICDSC, and DSM-IV-TR diagnoses were included. Between the scales, the prevalence of delirium ranged from 23.3% with the CAM-ICU, to 30.5% with the ICDSC, to 43.8% with the DSM-IV-TR criteria. The CAM-ICU showed only moderate concurrent validity (Cohen's κ = 0.44) and sensitivity (50%), but high specificity (95%). The ICDSC also reached moderate agreement (Cohen's κ = 0.60) and sensitivity (63%) while being very specific (95%). Between the CAM-ICU and the ICDSC, the concurrent validity was again only moderate (Cohen's κ = 0.56); however, the ICDSC yielded higher sensitivity and specificity (78 and 83%, respectively). SIGNIFICANCE OF RESULTS In the daily clinical routine, neither the CAM-ICU nor the ICDSC, common tools used in screening and detecting delirium in the intensive care setting, reached sufficient concurrent validity; nor did they outperform the DSM-IV-TR diagnostic criteria with respect to sensitivity or positive prediction, but they were very specific. Thus, the non-prediction by the CAM-ICU or ICDSC did not refute the presence of delirium. Between the CAM-ICU and ICDSC, the ICDSC proved to be the more accurate instrument.
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Nam ARN, Park JW. [Development of Korean Intensive Care Delirium Screening Tool (KICDST)]. J Korean Acad Nurs 2017; 46:149-58. [PMID: 26963424 DOI: 10.4040/jkan.2016.46.1.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 08/24/2015] [Accepted: 11/12/2015] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was done to develop of the Korean intensive care delirium screening tool (KICDST). METHODS The KICDST was developed in 5 steps: Configuration of conceptual frame, development of preliminary tool, pilot study, reliability and validity test, development of final KICDST. Reliability tests were done using degree of agreement between evaluators and internal consistency. For validity tests, CVI (Content Validity Index), ROC (Receiver Operating Characteristics) analysis, known group technique and factor analysis were used. RESULTS In the reliability test, the degree of agreement between evaluators showed .80~1.00 and the internal consistency was KR-20=.84. The CVI was .83~1.00. In ROC analysis, the AUC (Area Under the ROC Curve) was .98. Assessment score was 4 points. The values for sensitivity, specificity, correct classification rate, positive predictive value, and negative predictive value were found to be 95.0%, 93.7%, 94.4%, 95.0% and 93.7%, respectively. In the known group technique, the average delirium screening tool score of the non-delirium group was 1.25±0.99 while that of delirium group was 5.07±1.89 (t=-16.33, p<.001). The factors were classified into 3 factors (cognitive change, symptom fluctuation, psychomotor retardation), which explained 67.4% of total variance. CONCLUSION Findings show that the KICDST has high sensitivity and specificity. Therefore, this screening tool is recommended for early identification of delirium in intensive care patients.
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Affiliation(s)
- Ae Ri Na Nam
- Department of Nursing, Ajou University Medical Center·Nursing Research Institute, Ajou University, Suwon, Korea.
| | - Jee Won Park
- College of Nursing·Nursing Research Institute, Ajou University, Suwon, Korea
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Lahariya S, Grover S, Bagga S, Sharma A. Phenomenology of delirium among patients admitted to a coronary care unit. Nord J Psychiatry 2016; 70:626-32. [PMID: 27329002 DOI: 10.1080/08039488.2016.1194467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM To study the phenomenology and motor sub-types of delirium in patients admitted in a Coronary Care Unit (CCU). METHODS Three hundred and nine consecutive patients were screened for delirium, and those found positive for the same were evaluated by a psychiatrist on DSM-IVTR criteria to confirm the diagnosis. Those with a diagnosis of delirium were evaluated on the DRS-R-98 to study the phenomenology and on the amended Delirium Motor Symptom Scale (DMSS) to study the motor sub-types. RESULTS Eighty-one patients were found to have delirium. Commonly seen symptoms of delirium included: disturbances in sleep-wake cycle, lability of affect, thought abnormality, disturbance in attention, disorientation, short-term memory, and long-term memory. Very few patients had delusions. More than half of the participants were categorized as having hyperactive (n = 46; 56.8%) followed by hypoactive sub-type (n = 21; 26%) and mixed sub-type (n = 9; 11.1%) of delirium. There were minor differences in the frequency and severity of symptoms of delirium between incidence and prevalence cases of delirium and those with different motoric sub-types. CONCLUSION Delirium in CCU set-up is characterized by the symptoms of disturbances in sleep-wake cycle, lability of affect, thought abnormality, disturbance in attention, disorientation, short-term memory, and long-term memory. Hyperactive delirium is more common than hypoactive delirium.
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Affiliation(s)
- Sanjay Lahariya
- a Department of Psychiatry , Postgraduate Institute of Medical Education & Research , Chandigarh , India
| | - Sandeep Grover
- a Department of Psychiatry , Postgraduate Institute of Medical Education & Research , Chandigarh , India
| | - Shiv Bagga
- a Department of Psychiatry , Postgraduate Institute of Medical Education & Research , Chandigarh , India
| | - Akhilesh Sharma
- a Department of Psychiatry , Postgraduate Institute of Medical Education & Research , Chandigarh , India
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Evans AS, Weiner MM, Arora RC, Chung I, Deshpande R, Varghese R, Augoustides J, Ramakrishna H. Current approach to diagnosis and treatment of delirium after cardiac surgery. Ann Card Anaesth 2016; 19:328-37. [PMID: 27052077 PMCID: PMC4900348 DOI: 10.4103/0971-9784.179634] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/09/2016] [Indexed: 01/12/2023] Open
Abstract
Delirium after cardiac surgery remains a common occurrence that results in significant short- and long-term morbidity and mortality. It continues to be underdiagnosed given its complex presentation and multifactorial etiology; however, its prevalence is increasing given the aging cardiac surgical population. This review highlights the perioperative risk factors, tools to assist in diagnosing delirium, and current pharmacological and nonpharmacological therapy options.
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Affiliation(s)
- Adam S. Evans
- Department of Anesthesiology, Cleveland Clinic Florida, Weston, Florida, USA
| | - Menachem M. Weiner
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Insung Chung
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ranjit Deshpande
- Department of Anesthesiology, Yale University, New Haven, CT, USA
| | - Robin Varghese
- Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Augoustides
- Department of Anesthesiology, University of Pennsylvania, PA, USA
| | - Harish Ramakrishna
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, United States
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Grover S, Kate N, Sharma A, Mattoo SK, Basu D, Chakrabarti S, Malhotra S, Avasthi A. Symptom profile of alcohol withdrawal delirium: factor analysis of Delirium Rating Scale-Revised-98 version. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:196-202. [PMID: 26905794 DOI: 10.3109/00952990.2015.1130711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The symptom profile of alcohol withdrawal delirium (AWD), relative to deliriums of other etiology, remains uncertain. OBJECTIVE To evaluate the factor structure of symptoms in patients with AWD, as assessed by the Delirium Rating Scale-Revised-98 (DRS-R-98). METHOD A total of 112 patients aged 18 years or more with AWD were assessed on DRS-R-98. RESULTS The mean age of participants was 44.2 years. About two-third of the patients developed delirium within 24 hours of the last intake of alcohol and the mean duration of delirium at the time of assessment was 3.9 days. In 46% of cases the delirium was attributed solely to alcohol withdrawal; in the remaining subjects alcohol withdrawal was a major contributory factor. Three separate principal component analysis (whole sample, pure AWD and AWD with associated etiologies) were carried out. In all the factor analyses, one of the factors included cognitive symptoms (attention, orientation and visuospatial disturbances) along with or without short- and long-term memory impairment; the second factor included motoric symptoms along with sleep-wake cycle disturbances; the third factor included psychotic symptoms. For the whole group and subgroup of AWD with associated etiologies, items of higher level thinking (i.e. language disturbances and thought process abnormality) loaded along with cognitive symptoms. In pure AWD group, these items along with memory disturbances loaded with psychotic symptoms. CONCLUSIONS Results of the current factor analyses suggest that the factor structure of pure AWD is different from AWD with associated etiologies. Hence, attention to the symptom profile of patients with AWD may provide clues to delirium etiology.
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Affiliation(s)
- Sandeep Grover
- a Department of Psychiatry , Postgraduate Institute of Medical Education & Research , Chandigarh , India
| | - Natasha Kate
- a Department of Psychiatry , Postgraduate Institute of Medical Education & Research , Chandigarh , India
| | - Akhilesh Sharma
- a Department of Psychiatry , Postgraduate Institute of Medical Education & Research , Chandigarh , India
| | - Surendra K Mattoo
- a Department of Psychiatry , Postgraduate Institute of Medical Education & Research , Chandigarh , India
| | - Debasish Basu
- a Department of Psychiatry , Postgraduate Institute of Medical Education & Research , Chandigarh , India
| | - Subho Chakrabarti
- a Department of Psychiatry , Postgraduate Institute of Medical Education & Research , Chandigarh , India
| | - Savita Malhotra
- a Department of Psychiatry , Postgraduate Institute of Medical Education & Research , Chandigarh , India
| | - Ajit Avasthi
- a Department of Psychiatry , Postgraduate Institute of Medical Education & Research , Chandigarh , India
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Sensitivity and specificity of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for detecting post-cardiac surgery delirium: A single-center study in Japan. Heart Lung 2016; 45:15-20. [DOI: 10.1016/j.hrtlng.2015.11.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/14/2015] [Accepted: 11/06/2015] [Indexed: 11/20/2022]
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Vahedian Azimi A, Ebadi A, Ahmadi F, Saadat S. Delirium in Prolonged Hospitalized Patients in the Intensive Care Unit. Trauma Mon 2015; 20:e17874. [PMID: 26290854 PMCID: PMC4538727 DOI: 10.5812/traumamon.17874] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/13/2014] [Accepted: 04/30/2014] [Indexed: 01/08/2023] Open
Abstract
Background: Prolonged hospitalization in the intensive care unit (ICU) can impose long-term psychological effects on patients. One of the most significant psychological effects from prolonged hospitalization is delirium. Objectives: The aim of this study was to assess the effect of prolonged hospitalization of patients and subsequent delirium in the intensive care unit. Patients and Methods: This conventional content analysis study was conducted in the General Intensive Care Unit of the Shariati Hospital of Tehran University of Medical Sciences, from the beginning of 2013 to 2014. All prolonged hospitalized patients and their families were eligible participants. From the 34 eligible patients and 63 family members, the final numbers of actual patients and family members were 9 and 16, respectively. Several semi-structured interviews were conducted face-to-face with patients and their families in a private room and data were gathered. Results: Two main themes from two different perspectives emerged, 'patients' perspectives' (experiences during ICU hospitalization) and 'family members' perspectives' (supportive-communicational experiences). The main results of this study focused on delirium, Patients' findings were described as pleasant and unpleasant, factual and delusional experiences. Conclusions: Family members are valuable components in the therapeutic process of delirium. Effective use of family members in the delirium caring process can be considered to be one of the key non-medical nursing components in the therapeutic process.
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Affiliation(s)
- Amir Vahedian Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Abbas Ebadi, Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, P.O. Box: 19575-174, Tehran, IR Iran. Tel: +98-9122149019, Fax: +98-2126127237, E-mail:
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
| | - Soheil Saadat
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
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Carvalho JPLM, de Almeida ARP, Gusmao-Flores D. Delirium rating scales in critically ill patients: a systematic literature review. Rev Bras Ter Intensiva 2015; 25:148-54. [PMID: 23917980 PMCID: PMC4031829 DOI: 10.5935/0103-507x.20130026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 05/08/2013] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To identify scales that can establish a quantitative assessment of delirium symptoms in critically ill patients through a systematic review. METHODS Studies that evaluated delirium stratification scales in patients hospitalized in intensive care units were selected in a search performed in the MedLine database. Validation studies of these scales and their target patient populations were analyzed, and we identified the examiner and the signs and symptoms evaluated. In addition, the duration of the application and the sensitivity and specificity of each scale were assessed. RESULTS Six scales were identified: the Delirium Detection Score, the Cognitive Test of Delirium, the Memorial Delirium Assessment Scale, the Intensive Care Delirium Screening Checklist, The Neelon and Champagne Confusion Scale and the Delirium Rating Scale-Revised-98. CONCLUSION The scales identified allow the stratification and monitoring of critically ill patients with delirium. Among the six scales, the most studied and best suited for use in the intensive care units was the Intensive Care Delirium Screening.
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Kose G, Bolu A, Ozdemir L, Acikel C, Hatipolu S. Reliability and Validity of the Intensive Care Delirium Screening Checklist in Turkish. Int J Nurs Knowl 2015; 27:119-24. [DOI: 10.1111/2047-3095.12090] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gulsah Kose
- School of Nursing; Gulhane Military Medical Academy; Hacettepe University; Ankara Turkey
| | - Abdullah Bolu
- Abdullah Bolu, MD; Department of Psychiatry and Mental Health; Gulhane Military Medical Academy; Hacettepe University; Ankara Turkey
| | - Leyla Ozdemir
- Faculty of Nursing; Hacettepe University; Ankara Turkey
| | - Cengizhan Acikel
- Department of Biostatistics; Gulhane Military Medical Academy; Gulhane Military Medical Academy; Ankara Turkey
| | - Sevgi Hatipolu
- School of Nursing; Gulhane Military Medical Academy; Ankara Turkey
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Neufeld KJ, Nelliot A, Inouye SK, Ely EW, Bienvenu OJ, Lee HB, Needham DM. Delirium diagnosis methodology used in research: a survey-based study. Am J Geriatr Psychiatry 2014; 22:1513-21. [PMID: 24745562 PMCID: PMC4164600 DOI: 10.1016/j.jagp.2014.03.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe methodology used to diagnose delirium in research studies evaluating delirium detection tools. METHODS The authors used a survey to address reference rater methodology for delirium diagnosis, including rater characteristics, sources of patient information, and diagnostic process, completed via web or telephone interview according to respondent preference. Participants were authors of 39 studies included in three recent systematic reviews of delirium detection instruments in hospitalized patients. RESULTS Authors from 85% (N = 33) of the 39 eligible studies responded to the survey. The median number of raters per study was 2.5 (interquartile range: 2-3); 79% were physicians. The raters' median duration of clinical experience with delirium diagnosis was 7 years (interquartile range: 4-10), with 5% having no prior clinical experience. Inter-rater reliability was evaluated in 70% of studies. Cognitive tests and delirium detection tools were used in the delirium reference rating process in 61% (N = 21) and 45% (N = 15) of studies, respectively, with 33% (N = 11) using both and 27% (N = 9) using neither. When patients were too drowsy or declined to participate in delirium evaluation, 70% of studies (N = 23) used all available information for delirium diagnosis, whereas 15% excluded such patients. CONCLUSION Significant variability exists in reference standard methods for delirium diagnosis in published research. Increasing standardization by documenting inter-rater reliability, using standardized cognitive and delirium detection tools, incorporating diagnostic expert consensus panels, and using all available information in patients declining or unable to participate with formal testing may help advance delirium research by increasing consistency of case detection and improving generalizability of research results.
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Affiliation(s)
- KJ Neufeld
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - A Nelliot
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - SK Inouye
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts USA,Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts USA
| | - EW Ely
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Center for Health Services Research, Vanderbilt School of Medicine, Nashville, Tennessee USA,Geriatric Research, Education and Clinical Center, (GRECC) Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee USA
| | - OJ Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - HB Lee
- Psychological Medicine Service, Yale-New Haven Hospital, New Haven, Connecticut USA
| | - DM Needham
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland USA,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
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Joudi M, Fathi M, Harati H, Joudi M, Izanloo A, Rahdari A, Soltani G. Evaluating the incidence of cognitive disorder following off-pump coronary artery bypasses surgery and its predisposing factors. Anesth Pain Med 2014; 4:e18545. [PMID: 25337473 PMCID: PMC4199213 DOI: 10.5812/aapm.18545] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/30/2014] [Accepted: 04/30/2014] [Indexed: 01/25/2023] Open
Abstract
Background: Cognitive disorder is a fluctuating cognitive destruction and a common problem for hospitalized patients, which leads to loss of consciousness. It is usually accompanied with increased mortality, prolonged hospital stay, and decreased rehabilitation. Objectives: The purpose of this study was to determine risk factors associated with cognitive disorder after open-heart surgery. Patients and Methods: In total, 171 patients who had undergone off-pump open-heart surgery and lacked any history of psychiatric disorders were enrolled. Samples were selected according to a purposive sampling method. The Mini-Mental State Examination questionnaire was used for these patients to assess the incidence of cognitive disorder 24 hours after the operation in ICU and to compare creatinine level, ESR, extubation time and patients’ age in the two groups, one with postoperative cognitive disorder and the other without it. Independent T-test was used to compare the two groups regarding any history of diseases such as diabetes, hypertension and hyperlipidemia, Chi square test was used. Results: In total, 75% of patients had postoperative cognitive disorder. There was a significant association between the history of high blood pressure, C-reactive protein and preoperative creatinine levels in both cognitive disorder and control groups. Conclusions: Given the significant prevalence of postoperative cognitive disorder and significant associatio n between the history of high blood pressure, C-reactive protein and preoperative creatinine and cognitive disorder, detection of patient’s clinical symptoms may improve diagnosis, treatment and prevention of this disorder.
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Affiliation(s)
- Marjan Joudi
- Department of Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Fathi
- Deapartment of Anesthesia, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Corresponding author: Mehdi Fathi, Deapartment of Anesthesia, Imam Reza Hospital, University of Medical Sciences, Mashhad, Iran. Tel: +98-5138525209, Fax: +98-5138525209, E-mail:
| | - Hadi Harati
- Department of Neurology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mitra Joudi
- Department of Psychiatry, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Azra Izanloo
- Department of Radiologic Technology, Faculty of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Rahdari
- Deapartment of Anesthesia, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghasem Soltani
- Deapartment of Anesthesia, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Neurological examination of critically ill patients: a pragmatic approach. Report of an ESICM expert panel. Intensive Care Med 2014; 40:484-95. [PMID: 24522878 DOI: 10.1007/s00134-014-3214-y] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Many patients admitted to the intensive care unit (ICU) have pre-existing or acquired neurological disorders which significantly affect their short-term and long-term outcomes. The ESICM Neuro Intensive Care Section convened an expert panel to establish a pragmatic approach to neurological examination (NE) of the critically ill patient. METHODS The group conducted a comprehensive review of published studies on the NE of patients with coma, delirium, seizures and neuromuscular weakness in critically ill patients. Quality of data was rated as high, moderate, low, or very low, and final recommendations as strong, weak, or best practice. SUMMARY AND CONCLUSIONS The group made the following recommendations: (1) NE should be performed in all patients admitted to ICUs; (2) NE should include an assessment of consciousness and cognition, brainstem function, and motor function; (3) sedation should be managed to maximize the clinical detection of neurological dysfunction, except inpatients with reduced intracranial compliance in whom withdrawal of sedation may be deleterious; (4) the need for additional tests, including neurophysiological and neuroradiological investigations, should be guided by the NE; (5) selected features of the NE have prognostic value which should be considered in well-defined patient populations.
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Critically ill elderly patients in a developing world--mortality and functional outcome at 1 year: a prospective single-center study. J Crit Care 2014; 29:474.e7-13. [PMID: 24581949 DOI: 10.1016/j.jcrc.2014.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 01/01/2014] [Accepted: 01/05/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE To study the mortality and outcome of critically ill elderly patients in a developing country with focus on nutritional and socioeconomic status. METHODS A prospective study of 109 patients (215 screened) admitted consecutively to the intensive care unit from 2011 to 2012. Demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, mechanical ventilation, Malnutrition Universal Screening Tool score, socioeconomic category, functional status, delirium, and length of stay were recorded. Telephonic assessment of outcome was done at 1 year. Appropriate statistical tests compared differences between subgroups. Multivariate analysis was performed on significant variables (P<.1) affecting mortality. RESULTS At 12 months after discharge, 46.8% of patients (mean age, 76.5±9.6 years; APACHEII, 22.7±6.4; and intensive care unit stay, 7.8±3.4 days) had died. Risk factors for mortality at 12 months were APACHE II score (P<.001; odds ratio [OR], 1.2; 95% confidence interval [CI], 1.1-1.3), severe malnutrition (P=.006; OR, 0.08; 95% CI, 0.01-0.48), and delirium (P=.03; OR, 0.32; 95% CI, 0.11-0.9). Risk factors for short-term mortality (at 28 days) were APACHE II score (P=.02; OR, 1.1 [1.0-1.2]) and premorbid functional status (P=.03; OR, 0.2 [0.1-0.8]). Kaplan-Meier survival analysis showed a significant association with malnutrition (log-rank test, P=.012) but not with socioeconomic category. Most (72%) of the survivors had a favorable functional status. CONCLUSIONS Malnutrition, delirium, and APACHEII were risk factors for long-term mortality. Survivors had a good functional outcome. Appropriate quality of life tools for this population need to be developed.
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KOGA Y, MURATA H, YAMASE H. Validity and Reliability of the Japanese Version of Intensive Care Delirium Screening Checklist(ICDSC). ACTA ACUST UNITED AC 2014. [DOI: 10.2342/ymj.63.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Abstract
OBJECTIVE To review delirium screening tools available for use in the adult ICU and PICU, to review evidence-based delirium screening implementation, and to discuss common pitfalls encountered during delirium screening in the ICU. DATA SOURCES Review of delirium screening literature and expert opinion. RESULTS Over the past decade, tools specifically designed for use in critically ill adults and children have been developed and validated. Delirium screening has been effectively implemented across many ICU settings. Keys to effective implementation include addressing barriers to routine screening, multifaceted training such as lectures, case-based scenarios, one-on-one teaching, and real-time feedback of delirium screening, and interdisciplinary communication through discussion of a patient's delirium status during bedside rounds and through documentation systems. If delirium is present, clinicians should search for reversible or treatable causes because it is often multifactorial. CONCLUSION Implementation of effective delirium screening is feasible but requires attention to implementation methods, including a change in the current ICU culture that believes delirium is inevitable or a normal part of a critical illness, to a future culture that views delirium as a dangerous syndrome which portends poor clinical outcomes and which is potentially modifiable depending on the individual patients circumstances.
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Delirium screening in critically ill patients. Crit Care Med 2013; 41:e2-3. [PMID: 23269167 DOI: 10.1097/ccm.0b013e31826be806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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The authors reply. Crit Care Med 2013; 41:e3. [PMID: 23269168 DOI: 10.1097/ccm.0b013e3182741ec0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Matarese M, Generoso S, Ivziku D, Pedone C, De Marinis MG. Delirium in older patients: a diagnostic study of NEECHAM Confusion Scale in surgical intensive care unit. J Clin Nurs 2012; 22:2849-57. [DOI: 10.1111/j.1365-2702.2012.04300.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2012] [Indexed: 01/13/2023]
Affiliation(s)
- Maria Matarese
- School of Nursing; Campus Bio-Medico of Rome University; Rome
| | - Stefano Generoso
- Surgical Intensive Care Unit; Azienda Ospedaliera San Camillo-Forlanini; Rome
| | | | - Claudio Pedone
- Geriatrics Department; Campus Bio-Medico of Rome University Hospital; Rome
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Abstract
OBJECTIVE Despite its frequency and impact, delirium in critically ill patients is poorly recognized. Our aim was to systematically review the accuracy of delirium screening instruments in critically ill patients. DATA SOURCE Systematic review and meta-analysis of publications between 1966 and 2011. The Medline and Embase databases were searched for studies on delirium in critically ill patients. STUDY SELECTION The meta-analysis was limited to studies in critically ill patients in intensive care units, surgical wards, or emergency rooms. The delirium screening tool had to be feasible in a clinical setting for use by a nonexpert. As the gold standard, delirium had to be diagnosed based on appropriate criteria by a delirium expert. DATA EXTRACTION The outcomes assessed were sensitivity, specificity, likelihood ratios, and summary receiver operating characteristics curves. DATA SYNTHESIS Sixteen studies covering 1,523 participants and five screening tools were included in the systematic review. The pooled sensitivities and specificities of Confusion Assessment Method for the Intensive Care Unit for detection of delirium in critically ill patients were 75.5% and 95.8%, and for Intensive Care Delirium Screening Checklist 80.1% and 74.6%, respectively. All but one study was performed in a research setting, and that one study suggested that with routine use of the Confusion Assessment Method for the Intensive Care Unit, half of the patients with delirium were not detected. CONCLUSIONS The Confusion Assessment Method for the Intensive Care Unit was the most specific bedside tool for the assessment of delirium in critically ill patients. However, there was significant heterogeneity of the results. These findings were largely obtained in research settings, and the low sensitivity of the Confusion Assessment Method for the Intensive Care Unit in routine, daily practice may limit its use as a screening test.
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Gusmao-Flores D, Salluh JIF, Chalhub RÁ, Quarantini LC. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R115. [PMID: 22759376 PMCID: PMC3580690 DOI: 10.1186/cc11407] [Citation(s) in RCA: 340] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/03/2012] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Delirium is a frequent form of acute brain dysfunction in critically ill patients, and several detection tools for it have been developed for use in the Intensive Care Unit (ICU). The objective of this study is to evaluate the current evidence on the accuracy of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for the diagnosis of delirium in critically ill patients. METHODS A systematic review was conducted to identify articles on the evaluation of the CAM-ICU and the ICDSC in ICU patients. A MEDLINE, SciELO, CINAHL and EMBASE databases search was performed for articles published in the English language, involving adult populations and comparing these diagnostic tools with the gold standard, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Results were summarized by meta-analysis. The QUADAS scale was used to assess the quality of the studies. RESULTS Nine studies evaluating the CAM-ICU (including 969 patients) and four evaluating the ICDSC (n = 361 patients) were included in the final analysis. The pooled sensitivity of the CAM-ICU was 80.0% (95% confidence interval (CI): 77.1 to 82.6%), and the pooled specificity was 95.9% (95% CI: 94.8 to 96.8%). The diagnostic odds ratio was 103.2 (95% CI: 39.6 to 268.8). The pooled area under the summary receiver operating characteristic curve (AUC) was 0.97. The pooled sensitivity of the ICDSC was 74% (95% CI: 65.3 to 81.5%), and the pooled specificity was 81.9% (95% CI: 76.7 to 86.4%). The diagnostic odds ratio was 21.5 (95% CI: 8.51 to 54.4). The AUC was 0.89. CONCLUSIONS The CAM-ICU is an excellent diagnostic tool in critically ill ICU patients, whereas the ICDSC has moderate sensitivity and good specificity. The available data suggest that both CAM-ICU and the ICDSC can be used as a screening tool for the diagnosis of delirium in critically ill patients.
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Current world literature. Curr Opin Psychiatry 2012; 25:251-9. [PMID: 22456191 DOI: 10.1097/yco.0b013e328352dd8d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cultural and Linguistic Validation of the Italian Version of the Intensive Care Delirium Screening Checklist. Dimens Crit Care Nurs 2012; 31:246-51. [DOI: 10.1097/dcc.0b013e318256e0cc] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Abstract
Over the years Consultation-Liaison (C-L) psychiatry has contributed significantly to the growth of the psychiatry and has brought psychiatry very close to the advances in the medicine. It has also led to changes in the medical education and in the providing comprehensive management to the physically ill. In India, although the General Hospital Psychiatric units were established in 1930s, C-L Psychiatry has never been the main focus of training and research. Hence there is an urgent need to improve C-L Psychiatry services and training to provide best and optimal care to the patients and provide best education to the trainees.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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