TY - JOUR
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 J.
AU - Hayat, Matthew J.
AU - Coughlin, Jennifer M.
AU - Huberman, Amy L.
AU - Leistikow, Nicole A.
AU - Krumm, Sharon K.
AU - Needham, Dale M.
N1 - Funding Information:
N.A.L. was supported by a Johns Hopkins School of Medicine/NIH Predoctoral Clinical Research Training Grant (no. 1TL1RR025007 ) and a Walker Award from the Department of Psychiatry . The authors thank all of the dedicated and hardworking oncology nursing and administrative staff members who helped with this project. In particular, the authors thank Laura Hoofring MSN, ARNP-PMH, their tireless psychiatric liaison nurse consultant, for educating and motivating the nursing and medical staffs; Gina, Szymanski, RN, MSN, Nancy Ruth, RN, BSN, MiKaela Olsen, RN, MSN, OCN, and Marie Swisher RN, MSN,OCN, who have lead and trained all of the nursing staff in delirium recognition and ICDSC use; Joyce Kane, RN, MSN, Barbara Kasecamp BS, who helped in collecting and collating the data, and Meghan Hoofring who entered all of our data. The authors also all of the patients who participated in this endeavor.
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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U2 - 10.1016/j.psym.2010.12.018
DO - 10.1016/j.psym.2010.12.018
M3 - Article
C2 - 21397105
AN - SCOPUS:79960953839
SN - 0033-3182
VL - 52
SP - 133
EP - 140
JO - Psychosomatics
JF - Psychosomatics
IS - 2
ER -