Comparison of delirium assessment tools in a mixed intensive care unit.
OBJECTIVE
Delirium is a frequent problem in the intensive care unit (ICU) associated with poor prognosis. Delirium in the ICU is underdiagnosed by nursing and medical staff. Several detection methods have been developed for use in ICU patients. The aim of this study was to compare the value of three detection methods (the Confusion Assessment Method for the ICU [CAM-ICU], the Intensive Care Delirium Screening Checklist [ICDSC] and the impression of the ICU physician with the diagnosis of a psychiatrist, neurologist, or geriatrician).


METHODS
Prospective study.


METHODS
During an 8-month period, 126 patients (mean age 62.4 years, sd 15.0; mean Acute Physiology and Chronic Health Evaluation II score 20.9, sd 7.5) admitted to a 32-bed mixed medical and surgical ICU were studied.


METHODS
The included patients were assessed independently by trained ICU nurses using either the CAM-ICU or the ICDSC. Furthermore, the ICU physician was asked whether a patient was delirious or not. A psychiatrist, geriatrician, or neurologist serving as reference rater diagnosed delirium using established criteria.


RESULTS
The CAM-ICU showed superior sensitivity and negative predictive value (64% and 83%) compared with the ICDSC (43% and 75%). The ICDSC showed higher specificity and positive predictive value (95% and 82% vs. 88% and 72%). The sensitivity of the physicians view was only 29%.


CONCLUSIONS
ICU physicians underdiagnose delirium in the ICU, which underlines the necessity of standard evaluation in all critically ill patients. In our mixed ICU population, the CAM-ICU had a higher sensitivity than the ICDSC.
van Eijk
Maarten M J
MM
Department of Intensive Care, University Medical Center Utrecht, the Netherlands.
van Marum
Rob J
RJ
Klijn
Ine A M
IA
de Wit
Nelleke
N
Kesecioglu
Jozef
J
Slooter
Arjen J C
AJ
D000368:Aged; D003693:Delirium / Q000175:diagnosis*; D003943:Diagnostic Techniques, Neurological; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies