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Observational Study
. 2024 May;37(3):407-413.
doi: 10.1016/j.aucc.2023.05.007. Epub 2023 Jul 10.

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

Marie O Collet  1 , Anne H Nielsen  2 , Laura K Larsen  3 , Eva Laerkner  4 , Janet Froulund Jensen  5 , Camilla B Mortensen  6 , Lene Lehmkuhl  7 , Linette Thorn  8 , Birgitte Sonne Rossen  9 , Tina Allerslev Nielsen  10 , Edel Laursen  11 , Louise Hvid Shiv  12 , Marianne Villumsen  13 , Mette Nygaard Rahr  14 , Helle Svenningsen  15
Affiliations
Observational Study

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

Marie O Collet et al. Aust Crit Care. 2024 May.

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.

Keywords: Critically ill; Delirium; Delirium severity; Intensive care unit; Screening method.

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Conflict of interest statement

Conflict of interest The authors have no known competing interests for this manuscript. All authors have contributed substantially to the draughting of the protocol, data collection, data analyses, and interpretation of the results. All authors have critically revised this manuscript and approved this version for submission for publication. The Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark, has received funding from Novo Nordisk Fonden (0072048) for another research project. The Department of Anesthesiology and Intensive Care, Gødstrup Hospital received funding from Novo Nordisk Fonden (19OC0058277) for another research project.

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