Hostname: page-component-848d4c4894-sjtt6 Total loading time: 0 Render date: 2024-06-25T06:51:43.459Z Has data issue: false hasContentIssue false
  • English
  • Français

Screening for delirium with the Intensive Care Delirium Screening Checklist (ICDSC): Symptom profile and utility of individual items in the identification of delirium dependent on the level of sedation

Published online by Cambridge University Press:  24 May 2018

Soenke Boettger ,
Rafael Meyer ,
André Richter ,
Susana Franco Fernandez ,
Alain Rudiger ,
Maria Schubert ,
Josef Jenewein  and
David Garcia Nuñez
Soenke Boettger*
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University Zurich, Zurich, Switzerland
Rafael Meyer
Affiliation:
Pychiatric Services Aargau AG, Departement Geronto- and NeuropsychiatryDättwil, Switzerland
André Richter
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University Zurich, Zurich, Switzerland
Susana Franco Fernandez
Affiliation:
Institute of Anaesthesiology, University Hospital Zurich, University Zurich, Zurich, Switzerland
Alain Rudiger
Affiliation:
Institute of Anaesthesiology, University Hospital Zurich, University Zurich, Zurich, Switzerland
Maria Schubert
Affiliation:
Inselspital, University Hospital Bern, Directorate of Nursing/MTT, Bern, Switzerland
Josef Jenewein
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University Zurich, Zurich, Switzerland
David Garcia Nuñez
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University Zurich, Zurich, Switzerland University Basel, University Hospital Basel, Basel, Switzerland
*
Author for correspondence: Soenke Boettger, Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University Zurich, Ramistrasse 100, 8091 Zurich, Switzerland. E-mail: soenke.boettger@usz.ch
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

The importance of the proper identification of delirium, with its high incidence and adversities in the intensive care setting, has been widely recognized. One common screening instrument is the Intensive Care Delirium Screening Checklist (ICDSC); however, the symptom profile and key features of delirium dependent on the level of sedation have not yet been evaluated.

Method

In this prospective cohort study, the ICDSC was evaluated versus the Diagnostic and Statistical Manual, 4th edition, text revision, diagnosis of delirium set as standard with respect to the symptom profile, and correct identification of delirium. The aim of this study was to identify key features of delirium in the intensive care setting dependent on the Richmond Agitation and Sedation Scale levels of sedation: drowsiness versus alert and calmness.

Result

The 88 delirious patients of 225 were older, had more severe disease, and prolonged hospitalization. Irrespective of the level of sedation, delirium was correctly classified by items related to inattention, disorientation, psychomotor alterations, inappropriate speech or mood, and symptom fluctuation. In the drowsy patients, inattention reached substantial sensitivity and specificity, whereas psychomotor alterations and sleep-wake cycle disturbances were sensitive lacked specificity. The positive prediction was substantial across items, whereas the negative prediction was only moderate. In the alert and calm patient, the sensitivities were substantial for psychomotor alterations, sleep-wake cycle disturbances, and symptom fluctuations; however, these fluctuations were not specific. The positive prediction was moderate and the negative prediction substantial. Between the nondelirious drowsy and alert, the symptom profile was similar; however, drowsiness was associated with alterations in consciousness.

Significance of results

In the clinical routine, irrespective of the level of sedation, delirium was characterized by the ICDSC items for inattention, disorientation, psychomotor alterations, inappropriate speech or mood and symptom fluctuation. Further, drowsiness caused altered levels of consciousness.

Keywords

Deliriumintensive care unit (ICU)phenomenologyIntensive Care Delirium Screening Checklist (ICDSC)Diagnostic and Statistical Manual, 4th edition, text revision (DSM-IV-TR)Richmond Agitation and Sedation Scale (RASS)
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 1 , February 2019 , pp. 74 - 81
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edition, text revision. Washington, DC, American Psychiatric Association. 124–127.Google Scholar
Balas, MC et al. (2009) Outcomes associated with delirium in older patients in surgical ICUs. Chest 135(1), 18–25.Google Scholar
Bickel, H et al. (2008) High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study. Dementia and Geriatric Cognitive Disorders 26(1), 26–31.Google Scholar
Boettger, S et al. (2017a) Delirium in the intensive care setting and the Richmond Agitation and Sedation Scale (RASS): Drowsiness increases the risk and is subthreshold for delirium. Journal of Psychosomatic Research 103, 133–139.Google Scholar
Boettger, S et al. (2017b) Delirium in the intensive care setting: A reevaluation of the validity of the CAM-ICU and ICDSC versus the DSM-IV-TR in determining a diagnosis of delirium as part of the daily clinical routine. Palliative and Supportive Care 15(6), 1–9.Google Scholar
Bucht, G, Gustafson, Y, and Sandberg, O (1999) Epidemiology of delirium. Dementia and Geriatric Cognitive Disorders 10, 315–318.Google Scholar
DeVellis, RF (2012) Scale development: Theory and applications. Los Angeles, CA: Sage Publications.Google Scholar
Devlin, JW et al. (2007) Use of a validated delirium assessment tool improves the ability of physicians to identify delirium in medical intensive care unit patients. Critical Care Medicine 35(12), 2721–2724.Google Scholar
Ely, EW et al. (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Journal of the American Medical Association 291, 1753–1762.Google Scholar
Gottesman, RF et al. (2010) Delirium after coronary artery bypass graft surgery and late mortality. Annals of Neurology 67(3), 338–344.Google Scholar
Gusmao-Flores, D et al. (2012) The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Critical Care 16(4), R115.Google Scholar
Heymann, A et al. (2010) Delayed treatment of delirium increases mortality rate in intensive care unit patients. The Journal of International Medical Research 38(5), 1584–1595.Google Scholar
Inouye, SK, Westendorp, RG, and Saczynski, JS (2014). Delirium in elderly people. Lancet 383(9920), 911–922.Google Scholar
Koster, S, Hensens, AG, and van der Palen, J (2009) The long-term cognitive and functional outcomes of postoperative delirium after cardiac surgery. Annals of Thoracic Surgery 87(5), 1469–1474.Google Scholar
Lahariya, S et al. (2016) Phenomenology of delirium among patients admitted to a coronary care unit. Nordic Journal of Psychiatry 70(8), 626–632.Google Scholar
Marquis, F et al. (2007) Individual delirium symptoms: Do they matter? Critical Care Medicine 35, 2533–2537.Google Scholar
Meagher, DJ and Trzepacz, P (2009) Delirium. In Oxford textbook of psychiatry. Gelder, M, Andreasen, N, Lopez-Ibor, JJ, et al. (eds.), pp. 325–332. Oxford, UK: Oxford University Press.Google Scholar
Neufeld, KJ et al. (2013) Evaluation of two delirium screening tools for detecting post-operative delirium in the elderly. British Journal of Anaesthesia 111(4), 612–618.Google Scholar
Norkiene, I et al. (2007) Incidence and precipitating factors of delirium after coronary artery bypass grafting. Scandinavian Cardiovascular Journal 41, 180–185.Google Scholar
Ouimet, S et al. (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Medicine 33, 66–73.Google Scholar
Pun, BT and Ely, EW (2007) The importance of diagnosing and managing ICU delirium. Chest 132, 624–636.Google Scholar
Rosen, SF et al. (2002) Transient advanced mental impairment: an underappreciated morbidity after aortic surgery. Journal of Vascular Surgery 35(2), 376–381.Google Scholar
Santos, FS, Velasco, IT, and Fraguas, R Jr (2004) Risk factors for delirium in the elderly after coronary artery bypass graft surgery. International Psychogeriatrics 16(2), 175–193.Google Scholar
Sessler, CN et al. (2002) The Richmond Agitation-Sedation Scale: Validity and reliability in adult intensive care unit patients. American Journal of Respiratory and Critical Care Medicine 166, 1338–1344.Google Scholar
Sharma, A et al. (2012) Incidence, prevalence, risk factor and outcome of delirium in intensive care unit: A study from India. General Hospital Psychiatry 34(6), 639–646.Google Scholar
Trzepacz, PT et al. (1999) Practice guideline for the treatment of patients with delirium. American Psychiatric Association. American Journal of Psychiatry 156, 1–20.Google Scholar
van Eijk, MM et al. (2009) Comparison of delirium assessment tools in a mixed intensive care unit. Critical Care Medicine 37(6), 1881–1885.Google Scholar