The CAM-ICU-7 and ICDSC As Measures of Delirium Severity in Critically Ill Adult Patients

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2020 Nov 16

PMID 33196655

Citations 10

Authors

Karla D Krewulak

Brianna K Rosgen

E W Ely

Henry T Stelfox

Kirsten M Fiest

Affiliations

Soon will be listed here.

Abstract

Background: In clinical practice, a dichotomous approach to delirium identification may no longer be relevant when existing delirium screening tools measure a range of scores. The objective of this study was to compare the Confusion Assessment Method for the Intensive Care Unit 7-item (CAM-ICU-7) and the Intensive Care Delirium Screening Checklist (ICDSC) as measures of the spectrum of delirium severity in critically ill adult patients.

Methods: In this cross-sectional study, 218 patients underwent 641 paired assessments by bedside nurses (ICDSC, as per usual care) and trained research assistants (CAM-ICU-7). Correlation between the CAM-ICU-7 and ICDSC scores was evaluated. Logistic regression was used to explore associations between CAM-ICU-7 or ICDSC score and length of ICU stay and mechanical ventilation (receipt, ≥96 hours).

Results: Delirium prevalence evaluated by the CAM-ICU-7 and ICDSC were 46.3% (95% CI:39.7-53.0) and 34.4% (95% CI:28.3-41.0). Prevalence of less than clinical threshold symptoms of delirium evaluated by the CAM-ICU-7 (score: 1-2) and ICDSC (score: 1-3) were 30.3% (95%CI:24.5-36.7) and 50.9% (95%CI:44.3-57.6). The CAM-ICU-7 and ICDSC had significant positive correlation (0.58, p<0.001). Agreement between the tools as measures of delirium was moderate (kappa = 0.51) and as measures of less than clinical threshold symptoms of delirium was fair (kappa = 0.21). Less than clinical threshold symptoms of delirium identified by the ICDSC, not CAM-ICU-7, were associated with prolonged length of ICU stay (≥7 days) in patients <65 years of age [Odds Ratio (OR) 9.2, 95% CI:2.5-34.0] and mechanical ventilation (receipt: OR 2.8, 95% CI:1.3-6.4; ≥96 hours: OR 6.6, 95% CI:1.9-22.9), when compared to patients with no delirium.

Conclusions: The CAM-ICU-7 and ICDSC are measures of the spectrum of delirium severity that are closely correlated. Less than clinical threshold symptoms of delirium measure by the ICDSC is a better predictor of outcomes, when compared with the CAM-ICU-7.

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References

Yamada C, Iwawaki Y, Harada K, Fukui M, Morimoto M, Yamanaka R . Frequency and risk factors for subsyndromal delirium in an intensive care unit. Intensive Crit Care Nurs. 2018; 47:15-22. DOI: 10.1016/j.iccn.2018.02.010. View

Detroyer E, Timmermans A, Segers D, Meyfroidt G, Dubois J, Van Assche A . 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. PMC: 7149913. DOI: 10.1186/s12912-020-00415-z. View

Devlin J, Skrobik Y, Gelinas C, Needham D, Slooter A, Pandharipande P . Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018; 46(9):e825-e873. DOI: 10.1097/CCM.0000000000003299. View

Khan B, Perkins A, Hui S, Gao S, Campbell N, Farber M . Relationship Between African-American Race and Delirium in the ICU. Crit Care Med. 2016; 44(9):1727-34. PMC: 5240583. DOI: 10.1097/CCM.0000000000001813. View

Ely E, Margolin R, Francis J, May L, Truman B, Dittus R . Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001; 29(7):1370-9. DOI: 10.1097/00003246-200107000-00012. View

Ouimet S, Riker R, Bergeron N, Bergeon N, Cossette M, Kavanagh B . Subsyndromal delirium in the ICU: evidence for a disease spectrum. Intensive Care Med. 2007; 33(6):1007-13. DOI: 10.1007/s00134-007-0618-y. View

Inouye S, Westendorp R, Saczynski J . Delirium in elderly people. Lancet. 2013; 383(9920):911-22. PMC: 4120864. DOI: 10.1016/S0140-6736(13)60688-1. View

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014; 12(12):1495-9. DOI: 10.1016/j.ijsu.2014.07.013. View

Rose L, McGinlay M, Amin R, Burns K, Connolly B, Hart N . Variation in Definition of Prolonged Mechanical Ventilation. Respir Care. 2017; 62(10):1324-1332. DOI: 10.4187/respcare.05485. View

10.

van Eijk M, van Marum R, Klijn I, de Wit N, Kesecioglu J, Slooter A . Comparison of delirium assessment tools in a mixed intensive care unit. Crit Care Med. 2009; 37(6):1881-5. DOI: 10.1097/CCM.0b013e3181a00118. View

11.

Zilberberg M, de Wit M, Pirone J, Shorr A . Growth in adult prolonged acute mechanical ventilation: implications for healthcare delivery. Crit Care Med. 2008; 36(5):1451-5. DOI: 10.1097/CCM.0b013e3181691a49. View

12.

Khan B, Perkins A, Gao S, Hui S, Campbell N, Farber M . The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU. Crit Care Med. 2017; 45(5):851-857. PMC: 5392153. DOI: 10.1097/CCM.0000000000002368. View

13.

Ely E, Inouye S, Bernard G, Gordon S, Francis J, May L . Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001; 286(21):2703-10. DOI: 10.1001/jama.286.21.2703. View

14.

Gusmao-Flores D, Salluh J, Chalhub R, Quarantini L . 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. Crit Care. 2012; 16(4):R115. PMC: 3580690. DOI: 10.1186/cc11407. View

15.

Zaal I, Devlin J, Peelen L, Slooter A . A systematic review of risk factors for delirium in the ICU. Crit Care Med. 2014; 43(1):40-7. DOI: 10.1097/CCM.0000000000000625. View

16.

Pandharipande P, Cotton B, Shintani A, Thompson J, Pun B, Morris Jr J . Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients. J Trauma. 2008; 65(1):34-41. PMC: 3773485. DOI: 10.1097/TA.0b013e31814b2c4d. View

17.

Teasdale G, Jennett B . Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974; 2(7872):81-4. DOI: 10.1016/s0140-6736(74)91639-0. View

18.

Bergeron N, Dubois M, Dumont M, Dial S, Skrobik Y . Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001; 27(5):859-64. DOI: 10.1007/s001340100909. View

19.

Pulak L, Jensen L . Sleep in the Intensive Care Unit: A Review. J Intensive Care Med. 2014; 31(1):14-23. DOI: 10.1177/0885066614538749. View

20.

Plaschke K, Von Haken R, Scholz M, Engelhardt R, Brobeil A, Martin E . Comparison of the confusion assessment method for the intensive care unit (CAM-ICU) with the Intensive Care Delirium Screening Checklist (ICDSC) for delirium in critical care patients gives high agreement rate(s). Intensive Care Med. 2007; 34(3):431-6. DOI: 10.1007/s00134-007-0920-8. View