Implications of objective vs subjective delirium assessment in surgical intensive care patients.
BACKGROUND
Delirium is an independent predictor of increased length of stay, mortality, and treatment costs in critical care patients. Its incidence may be underestimated or overestimated if delirium is assessed by using subjective clinical impression alone rather than an objective instrument.


OBJECTIVE
To determine frequency of discrepancies between subjective and objective delirium monitoring.


METHODS
An observational cohort study was performed in a surgical-cardiosurgical 31-bed intensive care unit of a university hospital. Patients' delirium status was rated daily by bedside nurses on the basis of subjective individual clinical impressions and by medical students on the basis of scores on the objective Confusion Assessment Method for the Intensive Care Unit.


RESULTS
Of 160 patients suitable for analysis, 38.8% (n = 62) had delirium according to objective criteria at some time during their stay in the intensive care unit. A total of 436 paired observations were analyzed. Delirium was diagnosed in 26.1% of observations (n = 114) with the objective method. This percentage included 6.4% (n = 28) in whom delirium was not recognized via subjective criteria. According to subjective criteria, delirium was present in 29.4% of paired observations (n = 128), including 9.6% (n = 42) with no objective indications of delirium. A total of 8 patients with no evidence of delirium according to the objective criteria were prescribed haloperidol and lorazepam because the subjective method indicated they had delirium.


CONCLUSIONS
Use of objective criteria helped detect delirium in more patients and also identified patients mistakenly thought to have delirium who actually did not meet objective criteria for diagnosis of the condition.
Clinic of Anesthesiology and Intensive Care, Bonn University Hospital, Germany. u.guenther@uni-bonn.de
Ulf
U
Guenther
Jan
J
Weykam
Ulrich
U
Andorfer
Nils
N
Theuerkauf
Julius
J
Popp
E Wesley
EW
Ely
Christian
C
Putensen
D018806:APACHE; D000368:Aged; D000465:Algorithms; D003422:Critical Care / Q000379:methods*; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019370:Observation; D011446:Prospective Studies; D015203:Reproducibility of Results