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Abstract

Introduction: We assessed whether it is feasible to routinely perform systematic evaluations of analgesia, sedation level, and delirium in the NICU population, evaluated the inter-rater reliability of standardized assessment tools, and describe individual features of delirium screened with the Intensive Care Delirium Screening Checklist (ICDSC). Hypothesis: Assessments are feasible and reliable. Methods: Systematic assessments were simultaneously and independently performed by a neurologist, or trauma surgeon, and a nurse. Pain was evaluated with the Numeric rating scale (NRS) or Behaviour Pain Scale (BPS). Sedation was assessed with the Richmond Agitation-Sedation Scale (RASS). Patients with RASS?-4 were screened for features of delirium with the Intensive Care Delirium Screening Checklist (ICDSC). Intraclass correlation coefficient (ICC) was used to evaluate inter-rater reliability between the nurse and physician for pain and sedation scales and the Kappa coefficient was calculated for concordance of the ICDSC items. Results: 151 patients had 439 assessments. Pain and sedation were always assessable with excellent inter-rater reliability (NRS ICC 0.92, BPS ICC 0.83, and RASS ICC 0.92). Patients were sufficiently alert for delirium screening 3/4 of the time; ICDSC items had good concordance (Kappa coefficients between 0.58 and 0.91 for the 8 ICDSC items). Non-evaluable items were most often orientation, hallucinations, and speech or mood content. Moreover, each additional ICDSC item present in proportion to the total evaluable ICDSC score was associated with a 10% increase in ICU length of stay. Conclusions: Pain and sedation can be systematically assessed in the neurologically critically ill; the majority can also be screened for delirium features with excellent inter-rater reliability. Increased proportion of ICDSC items is associated with worse outcomes.