Delirium and delirium severity screening in the intensive care-correspondence of screenings tools

TY - JOUR

T1 - Delirium and delirium severity screening in the intensive care-correspondence of screenings tools

AU - Collet, Marie Oxenbøll

AU - Nielsen, Anne H

AU - Larsen, Laura K

AU - Laerkner, Eva

AU - Jensen, Janet Froulund

AU - Mortensen, Camilla B

AU - Lehmkuhl, Lene

AU - Thorn, Linette

AU - Rossen, Birgitte Sonne

AU - Nielsen, Tina Allerslev

AU - Laursen, Edel

AU - Shiv, Louise Hvid

AU - Villumsen, Marianne

AU - Rahr, Mette Nygaard

AU - Svenningsen, Helle

N1 - Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

PY - 2024/5

Y1 - 2024/5

N2 - Background: Delirium severity scores are gaining acceptance for measuring delirium in the intensive care unit (ICU). Objective: The aim of this study was to evaluate the concordance between the Confusion Assessment Method for the intensive care unit (CAM-ICU)-7 and the Intensive Care Delirium Screening Checklist (ICDSC) as delirium severity measurement tools. Methods: This was a prospective, comparative, observational multicentre study. This study was conducted in 18 Danish ICUs. Delirium was assessed in adult critically ill patients admitted to an ICU with a Richmond Agitation and Sedation Score (RASS) of −2 or above. ICU nurses assessed delirium with randomised paired delirium screening instruments, using the CAM-ICU, the ICDSC, and the CAM-ICU-7. The correlation between the CAM-ICU-7 and the ICDSC severity scores was evaluated for all predefined patient subgroups. Results: A total of 1126 paired screenings were conducted by 127 ICU nurses in 850 patients. The patients' median age was 70 years (interquartile range: 61–77), 40% (339/850) were female, and 54% (457/850) had at least one positive delirium score. Delirium severity ranges (CAM-ICU-7: 0–7; and ICDSC: 0–8) were positively correlated (Pearson's correlation coefficient, r = 0.83; p < 0.0001). The overall agreement between the CAM-ICU-7 and the ICDSC for delirium measurement (CAM-ICU-7: >2, and ICDSC: >3) was substantial (kappa = 0.74), but the agreement decreased to fair (kappa = 0.38) if a patient had a RASS less than 0. Conclusions: The agreement between the CAM-ICU-7 and the ICDSC for delirium severity measurement was substantial but might be affected by the patient's sedation and agitation level at the time of assessment. Implications for practice: Both CAM-ICU-7 and ICDSC can be implemented for delirium severity measurement. Attention is warranted in both scores if a patient has a RASS of −2.

AB - Background: Delirium severity scores are gaining acceptance for measuring delirium in the intensive care unit (ICU). Objective: The aim of this study was to evaluate the concordance between the Confusion Assessment Method for the intensive care unit (CAM-ICU)-7 and the Intensive Care Delirium Screening Checklist (ICDSC) as delirium severity measurement tools. Methods: This was a prospective, comparative, observational multicentre study. This study was conducted in 18 Danish ICUs. Delirium was assessed in adult critically ill patients admitted to an ICU with a Richmond Agitation and Sedation Score (RASS) of −2 or above. ICU nurses assessed delirium with randomised paired delirium screening instruments, using the CAM-ICU, the ICDSC, and the CAM-ICU-7. The correlation between the CAM-ICU-7 and the ICDSC severity scores was evaluated for all predefined patient subgroups. Results: A total of 1126 paired screenings were conducted by 127 ICU nurses in 850 patients. The patients' median age was 70 years (interquartile range: 61–77), 40% (339/850) were female, and 54% (457/850) had at least one positive delirium score. Delirium severity ranges (CAM-ICU-7: 0–7; and ICDSC: 0–8) were positively correlated (Pearson's correlation coefficient, r = 0.83; p < 0.0001). The overall agreement between the CAM-ICU-7 and the ICDSC for delirium measurement (CAM-ICU-7: >2, and ICDSC: >3) was substantial (kappa = 0.74), but the agreement decreased to fair (kappa = 0.38) if a patient had a RASS less than 0. Conclusions: The agreement between the CAM-ICU-7 and the ICDSC for delirium severity measurement was substantial but might be affected by the patient's sedation and agitation level at the time of assessment. Implications for practice: Both CAM-ICU-7 and ICDSC can be implemented for delirium severity measurement. Attention is warranted in both scores if a patient has a RASS of −2.

KW - Critically ill

KW - Delirium

KW - Delirium severity

KW - Intensive care unit

KW - Screening method

KW - Intensive Care Units

KW - Prospective Studies

KW - Humans

KW - Male

KW - Hospitalization

KW - Critical Care/methods

KW - Adult

KW - Female

KW - Aged

KW - Delirium/diagnosis

UR - http://www.scopus.com/inward/record.url?scp=85165238883&partnerID=8YFLogxK

U2 - 10.1016/j.aucc.2023.05.007

DO - 10.1016/j.aucc.2023.05.007

M3 - Journal article

C2 - 37438182

SN - 1036-7314

VL - 37

SP - 407

EP - 413

JO - Australian Critical Care

JF - Australian Critical Care

IS - 3

ER -