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

Marie O. Collet*, Anne H. Nielsen, Laura K. Larsen, Eva Laerkner, Janet Froulund Jensen, Camilla B. Mortensen, Lene Lehmkuhl, Linette Thorn, Birgitte Sonne Rossen, Tina Allerslev Nielsen, Edel Laursen, Louise Hvid Shiv, Marianne Villumsen, Mette Nygaard Rahr, Helle Svenningsen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

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.

Original languageEnglish
JournalAustralian Critical Care
Volume37
Issue number3
Pages (from-to)407-413
ISSN1036-7314
DOIs
Publication statusPublished - May 2024

Keywords

  • Critically ill
  • Delirium
  • Delirium severity
  • Intensive care unit
  • Screening method
  • Intensive Care Units
  • Prospective Studies
  • Humans
  • Male
  • Hospitalization
  • Critical Care/methods
  • Adult
  • Female
  • Aged
  • Delirium/diagnosis

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