Psychometric properties of the intensive care delirium screening checklist when used by bedside nurses in clinical practice: a prospective descriptive study

Elke Detroyer,Aimé Van Assche,Dana Segers,Koen Milisen,Jasperina Dubois,Geert Meyfroidt,Etienne Joosten,Annick Timmermans

doi:10.1186/s12912-020-00415-z

Abstract

BackgroundThe Intensive Care Delirium Screening Checklist (ICDSC) demonstrates good psychometric characteristics in research settings. However, evidence about these characteristics in pragmatic ICU settings is inconsistent. This study evaluated psychometric properties and user-friendliness of the ICDSC when administered by ICU nurses in daily practice.MethodsThis prospective study included 77 patients from a surgical intensive care unit. To examine the psychometric characteristics, the scores on the ICDSC (performed by bedside nurses) were compared with the scores on the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) (performed by researchers as gold standard). The user-friendliness was evaluated by 34 ICU nurses with a 20-item questionnaire.ResultsThe ICDSC had an area under the curve of 0.843. It showed a good diagnostic accuracy with a sensitivity of 81.0%, a specificity of 87.7%, and a 53.1% positive and 96.4% negative predictive value. The overall Cronbach’s alpha coefficient for all ICDSC scores was high (0.839). Overall, ICU nurses experienced the ICDSC as easy-to-use. The scale was usable in most surgical ICU patients. Yet, some nurses (11.8%) had problems to score the items ‘inappropriate speech’ and ‘symptom fluctuation’ in intubated patients.ConclusionsThe ICDSC is a valid and user-friendly tool for delirium screening in daily ICU nursing practice. Yet, some problems were reported in intubated patients. Therefore, validation studies with specific focus on intubated patients are needed.

Highlights

The Intensive Care Delirium Screening Checklist (ICDSC) demonstrates good psychometric characteristics in research settings
When CAM-intensive care unit (ICU) assessments were performed by nurses in clinical practice, the sensitivity of the tool is low which limits its use as a screening tool [15, 16]
This study aimed to investigate the diagnostic accuracy, concurrent validity and internal consistency of the ICDSC when performed by ICU nurses in clinical practice

Summary

Introduction

The Intensive Care Delirium Screening Checklist (ICDSC) demonstrates good psychometric characteristics in research settings Evidence about these characteristics in pragmatic ICU settings is inconsistent. Based on systematic reviews [10,11,12] and the guidelines of the Society of Critical Care Medicine Pain, Agitation and Delirium (PAD) [9], the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) [13] and the Intensive Care Delirium Screening Checklist (ICDSC) [14] are advised for delirium screening in the ICU Both tools are valid for delirium detection in ICU research settings. The ICDSC with its good sensitivity (range, 64–99%, depending on the used cutoff values) and its continuous scoring system based on routine care observations, seems to be useful for delirium screening in daily practice [10, 12, 17]. The user-friendliness of this scale in observing ICU patients during practice has been evaluated as secondary outcome

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