Recognition and labeling of delirium symptoms by intensivists: does it matter?
OBJECTIVE
The approach to acute cognitive dysfunction varies among physicians, including intensivists. Physicians may differ in their labeling of cognitive abnormalities in critically ill patients. We aimed to survey: (a) what Canadian intensive care unit (ICU) physicians identify as "delirium"; (b) choices of non-pharmacological and pharmacological management; and (c) consultation patterns among ICU patients with cognitive abnormalities.


METHODS
A mail-in self-administered survey was sent to Canadian intensivists registered with the Canadian Critical Care Society. The survey contained three clinical scenarios which described cognitively abnormal patients with: (a) hepatic encephalopathy; (b) multiple drug overdose; and (c) post-operative aortic aneurysm repair. Symptoms, which included fluctuating level of consciousness, inattention, disorientation, hallucinations, sleep/wake cycle disturbance, and paranoia, all fulfilled DSM-IV criteria for delirium. We asked for diagnoses in short-answer format for each scenario, and offered multiple selections of non-pharmacological and pharmacological therapies and consultation options.


METHODS
All intensivists registered with the Canadian Critical Care Society.


RESULTS
One-hundred thirty surveys were returned, for a response rate of 58.3%. When an etiological cognitive dysfunction diagnosis was obvious, 83-85% responded with the medical diagnosis to explain the cognitive abnormalities; only 43-55% used the term "delirium". In contrast, where an underlying medical problem was lacking, 74% of respondents diagnosed "delirium" (p=0.002). Non-pharmacological and pharmacological management varied considerably by physician and scenario but independently from whether the term "delirium" was selected. Commonly selected pharmacological agents were antipsychotics and benzodiazepines, followed by narcotics, non-narcotic analgesics, and other sedatives. Whether and when intensivists chose to consult other services varied.


CONCLUSIONS
Canadian intensivists diagnose delirium based upon the presence or absence of an obvious medical etiology. Wide variation exists in approach to management, as well as patterns of consultation.
Cheung
Catherine Z
CZ
Department of Medicine, University of Toronto, M5G 2C4, Toronto, Ontario, Canada.
Alibhai
Shabbir M H
SM
Robinson
Michael
M
Tomlinson
George
G
Chittock
Dean
D
Drover
John
J
Skrobik
Yoanna
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis*; D003422:Critical Care / Q000379:methods*; D003693:Delirium / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'