Abstract
Background/ObjectiveDelirium is a common complication in critically ill patients with a negative impact on hospital length of stay, morbidity, and mortality. Little is known on how neurological deficits affect the outcome of commonly used delirium screening tools such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) in neurocritical care patients.MethodsOver a period of 1 month, all patients admitted to a neurocritical care and stroke unit at a single academic center were prospectively screened for delirium using both CAM-ICU and ICDSC. Tool-based delirium screening was compared with delirium evaluation by the treating clinical team. Additionally, ICD-10 delirium criteria were assessed.ResultsOne hundred twenty-three patients with a total of 644 daily screenings were included. Twenty-three patients (18.7%) were diagnosed with delirium according to the clinical evaluation. Delirium incidence amounted to 23.6% (CAM-ICU) and 26.8% (ICDSC). Sensitivity and specificity of both screening tools were 66.9% and 93.3% for CAM-ICU and 69.9% and 93.9% for ICDSC, respectively. Patients identified with delirium by either CAM-ICU or ICDSC presented a higher proportion of neurological deficits such as impaired consciousness, expressive aphasia, impaired language comprehension, and hemineglect. Subsequently, generalized estimating equations identified a significant association between impaired consciousness (as indexed by Richmond Agitation and Sedation Scale) and a positive delirium assessment with both CAM-ICU and ICDSC, while impaired language comprehension and hemineglect were only associated with a positive CAM-ICU result.ConclusionsA positive delirium screening with both CAM-ICU and ICDSC in neurocritical care and stroke unit patients was found to be significantly associated with the presence of neurological deficits. These findings underline the need for a more specific delirium screening tool in neurocritical care patients.
Highlights
IntroductionThe most frequently used instruments for standardized delirium screening on surgical and medical intensive care units are the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) [10] and the Intensive Care Delirium Screening Checklist (ICDSC) [11, 12]
Delirium is an acute mental disturbance characterized by impairment of consciousness, attention, andThe most frequently used instruments for standardized delirium screening on surgical and medical intensive care units are the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) [10] and the Intensive Care Delirium Screening Checklist (ICDSC) [11, 12]
In patients with mild to moderate traumatic brain injury, delirium was present in 45.9% of patients, but comparably low sensitivity and specificity for both tests were reported with 62% and 64% for CAM-ICU screening and 64% and 79% for ICDSC screening, respectively [18]
Summary
The most frequently used instruments for standardized delirium screening on surgical and medical intensive care units are the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) [10] and the Intensive Care Delirium Screening Checklist (ICDSC) [11, 12]. In those settings, the CAM-ICU has a reported sensitivity of 75.5% to 80% and a specificity of 95.8% to 95.9%, while the ICDSC has a sensitivity of 74% to 80.1% and a specificity of 74.6% to 81.9% [13, 14]. A significant number of patients had to be excluded or were not assessable due to a reduced level of consciousness [20]
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