Evaluation of Two Intensive Care Delirium Screening Tools for Non-Critically Ill Hospitalized Patients **Poster Presentation: American Psychopathological Association Annual Meeting; New York, NY, March 4, 2010

Research output: Contribution to journalArticle

Abstract

Background: Delirium is a common, yet frequently under-recognized medical/psychiatric complication for hospitalized patients, associated with substantial morbidity and mortality. While easy-to-use delirium screening tools exist for ventilated patients, their use in non-critically ill, hospitalized patients has not been validated. Methods: This prospective 4-week comparison of daily delirium status, using screening tools (Confusion Assessment Method for the Intensive Care Unit [CAM-ICU] and Intensive Care Delirium Screening Checklist [ICDSC]) vs. a daily neuropsychiatric examination as a reference standard, was conducted in 139 inpatients in two medical oncology units at a large teaching hospital during July, 2009. Results: Based on neuropsychiatric examination, 36 (26%) patients had at least 1 day of delirium during their hospital admission. For 21 (15%) patients, delirium was present at the initial assessment, while 15 (11%) developed delirium at a median (IQR) of three (2-7) subsequent assessments. Delirium was present on 20% of all patient-days. For the initial evaluation, the CAM-ICU had a sensitivity of 18% (95% confidence interval [CI], 5%-44%), and a sensitivity of 18% (9% -32%) when using all assessments, adjusting for repeated measures on each patient. The ICDSC had sensitivities of 47% (24%-72%) and 62% (49%-74%). The specificity of both instruments was very high (≥98%). Conclusions: This study suggests that in non-critically ill hospitalized patients, the CAM-ICU and ICDSC intensive care delirium screening tools are not adequately sensitive for use in routine clinical practice. Further work is needed to develop more sensitive, efficient tools in this population.

Original languageEnglish (US)
Pages (from-to)133-140
Number of pages8
JournalPsychosomatics
Volume52
Issue number2
DOIs
StatePublished - Mar 2011

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Posters
Delirium
Critical Care
Confusion
Checklist
Intensive Care Units
Intensive Care
Screening
Evaluation
Medical Oncology
Teaching Hospitals
Psychiatry
Inpatients
Confidence Intervals

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology
  • Arts and Humanities (miscellaneous)

Cite this

@article{3ed5a34c9da04696b5db6966379bd454,
title = "Evaluation of Two Intensive Care Delirium Screening Tools for Non-Critically Ill Hospitalized Patients **Poster Presentation: American Psychopathological Association Annual Meeting; New York, NY, March 4, 2010",
abstract = "Background: Delirium is a common, yet frequently under-recognized medical/psychiatric complication for hospitalized patients, associated with substantial morbidity and mortality. While easy-to-use delirium screening tools exist for ventilated patients, their use in non-critically ill, hospitalized patients has not been validated. Methods: This prospective 4-week comparison of daily delirium status, using screening tools (Confusion Assessment Method for the Intensive Care Unit [CAM-ICU] and Intensive Care Delirium Screening Checklist [ICDSC]) vs. a daily neuropsychiatric examination as a reference standard, was conducted in 139 inpatients in two medical oncology units at a large teaching hospital during July, 2009. Results: Based on neuropsychiatric examination, 36 (26{\%}) patients had at least 1 day of delirium during their hospital admission. For 21 (15{\%}) patients, delirium was present at the initial assessment, while 15 (11{\%}) developed delirium at a median (IQR) of three (2-7) subsequent assessments. Delirium was present on 20{\%} of all patient-days. For the initial evaluation, the CAM-ICU had a sensitivity of 18{\%} (95{\%} confidence interval [CI], 5{\%}-44{\%}), and a sensitivity of 18{\%} (9{\%} -32{\%}) when using all assessments, adjusting for repeated measures on each patient. The ICDSC had sensitivities of 47{\%} (24{\%}-72{\%}) and 62{\%} (49{\%}-74{\%}). The specificity of both instruments was very high (≥98{\%}). Conclusions: This study suggests that in non-critically ill hospitalized patients, the CAM-ICU and ICDSC intensive care delirium screening tools are not adequately sensitive for use in routine clinical practice. Further work is needed to develop more sensitive, efficient tools in this population.",
author = "Neufeld, {Karin Jane} and Hayat, {Matthew J.} and Coughlin, {Jennifer Marie} and Amy Huberman and Leistikow, {Nicole A.} and Sharon Krumm and Dale Needham",
year = "2011",
month = "3",
doi = "10.1016/j.psym.2010.12.018",
language = "English (US)",
volume = "52",
pages = "133--140",
journal = "Psychosomatics",
issn = "0033-3182",
publisher = "American Psychiatric Publishing Inc.",
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T1 - Evaluation of Two Intensive Care Delirium Screening Tools for Non-Critically Ill Hospitalized Patients **Poster Presentation

T2 - American Psychopathological Association Annual Meeting; New York, NY, March 4, 2010

AU - Neufeld, Karin Jane

AU - Hayat, Matthew J.

AU - Coughlin, Jennifer Marie

AU - Huberman, Amy

AU - Leistikow, Nicole A.

AU - Krumm, Sharon

AU - Needham, Dale

PY - 2011/3

Y1 - 2011/3

N2 - Background: Delirium is a common, yet frequently under-recognized medical/psychiatric complication for hospitalized patients, associated with substantial morbidity and mortality. While easy-to-use delirium screening tools exist for ventilated patients, their use in non-critically ill, hospitalized patients has not been validated. Methods: This prospective 4-week comparison of daily delirium status, using screening tools (Confusion Assessment Method for the Intensive Care Unit [CAM-ICU] and Intensive Care Delirium Screening Checklist [ICDSC]) vs. a daily neuropsychiatric examination as a reference standard, was conducted in 139 inpatients in two medical oncology units at a large teaching hospital during July, 2009. Results: Based on neuropsychiatric examination, 36 (26%) patients had at least 1 day of delirium during their hospital admission. For 21 (15%) patients, delirium was present at the initial assessment, while 15 (11%) developed delirium at a median (IQR) of three (2-7) subsequent assessments. Delirium was present on 20% of all patient-days. For the initial evaluation, the CAM-ICU had a sensitivity of 18% (95% confidence interval [CI], 5%-44%), and a sensitivity of 18% (9% -32%) when using all assessments, adjusting for repeated measures on each patient. The ICDSC had sensitivities of 47% (24%-72%) and 62% (49%-74%). The specificity of both instruments was very high (≥98%). Conclusions: This study suggests that in non-critically ill hospitalized patients, the CAM-ICU and ICDSC intensive care delirium screening tools are not adequately sensitive for use in routine clinical practice. Further work is needed to develop more sensitive, efficient tools in this population.

AB - Background: Delirium is a common, yet frequently under-recognized medical/psychiatric complication for hospitalized patients, associated with substantial morbidity and mortality. While easy-to-use delirium screening tools exist for ventilated patients, their use in non-critically ill, hospitalized patients has not been validated. Methods: This prospective 4-week comparison of daily delirium status, using screening tools (Confusion Assessment Method for the Intensive Care Unit [CAM-ICU] and Intensive Care Delirium Screening Checklist [ICDSC]) vs. a daily neuropsychiatric examination as a reference standard, was conducted in 139 inpatients in two medical oncology units at a large teaching hospital during July, 2009. Results: Based on neuropsychiatric examination, 36 (26%) patients had at least 1 day of delirium during their hospital admission. For 21 (15%) patients, delirium was present at the initial assessment, while 15 (11%) developed delirium at a median (IQR) of three (2-7) subsequent assessments. Delirium was present on 20% of all patient-days. For the initial evaluation, the CAM-ICU had a sensitivity of 18% (95% confidence interval [CI], 5%-44%), and a sensitivity of 18% (9% -32%) when using all assessments, adjusting for repeated measures on each patient. The ICDSC had sensitivities of 47% (24%-72%) and 62% (49%-74%). The specificity of both instruments was very high (≥98%). Conclusions: This study suggests that in non-critically ill hospitalized patients, the CAM-ICU and ICDSC intensive care delirium screening tools are not adequately sensitive for use in routine clinical practice. Further work is needed to develop more sensitive, efficient tools in this population.

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