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Ho MH, Montgomery A, Traynor V, Chang CC, Kuo KN, Chang HCR, Chen KH. Diagnostic Performance of Delirium Assessment Tools in Critically Ill Patients: A Systematic Review and Meta-Analysis. Worldviews Evid Based Nurs 2020; 17:301-310. [PMID: 32786067 DOI: 10.1111/wvn.12462] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical care nurses are in the best position to detect and monitor delirium in critically ill patients. Therefore, an optimum delirium assessment tool with strong evidence should be identified with critical care nurses to perform in the daily assessment. AIM To evaluate and compare the diagnostic performance of delirium assessment tools in diagnosing delirium in critically ill patients. METHODS We searched five electronic databases including the Cochrane Library, PubMed, Embase, CINAHL, and a Chinese database for eligible diagnostic studies published in English or Mandarin up to December 2018. This diagnostic test accuracy meta-analysis was limited to studies in intensive care unit (ICU) settings, using the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a standard reference to test the accuracy of delirium assessment tools. Eligible studies were critically appraised by two investigators independently. The summary of evidence was conducted for pooling and comparing diagnostic accuracy by a bivariate random effects meta-analysis model. The pooled sensitivities and specificities, summary receiver operating characteristic curve (sROC), the area under the curve (AUC), and diagnostic odds ratio (DOR) were calculated and plotted. The possibility of publication bias was assessed by Deeks' funnel plot. DATA SYNTHESIS We identified and evaluated 23 and 8 articles focused on CAM-ICU and ICDSC, respectively. The summary sensitivities of 0.85 and 0.87, and summary specificities of 0.95 and 0.91 were found for CAM-ICU and ICDSC, respectively. The AUC of the CAM-ICU was 0.96 (95% CI, 0.94-0.98), with DOR at 99 (95% CI, 55-177). The AUC of the ICDSC was 0.95 (95% CI, 0.92-0.96), and the DOR was 65 (95% CI, 27-153). LINKING EVIDENCE TO ACTION CAM-ICU demonstrated higher diagnostic test accuracy and is recommended as the optimal delirium assessment tool. However, the results should be interpreted with caution due to the between-study heterogeneity of this diagnostic test accuracy meta-analysis.
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Affiliation(s)
- Mu-Hsing Ho
- School of Nursing, Faculty of Science Medicine & Health, University of Wollongong, Wollongong, New South Wales, Australia.,Department of Nursing, ICU-3, Taipei Medical University Hospital, Taipei, Taiwan.,Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
| | - Amy Montgomery
- School of Nursing, Faculty of Science Medicine & Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia.,Aged Care Department, St. George Hospital, NSW Health, Kogarah, New South Wales, Australia
| | - Victoria Traynor
- School of Nursing, Faculty of Science Medicine & Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
| | - Chia-Chi Chang
- School of Nursing, Faculty of Science Medicine & Health, University of Wollongong, Wollongong, New South Wales, Australia.,School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.,College of Interdisciplinary Studies, Taipei Medical University, Taipei, Taiwan
| | - Ken N Kuo
- Cochrane Taiwan Taipei Medical University, Taipei, Taiwan.,Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Chen Rita Chang
- School of Nursing, Faculty of Science Medicine & Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
| | - Kee-Hsin Chen
- Cochrane Taiwan Taipei Medical University, Taipei, Taiwan.,Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Evidence-based Knowledge Translation Center, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
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Ho MH, Chen KH, Montayre J, Liu MF, Chang CC, Traynor V, Shen Hsiao ST, Chang HC(R, Chiu HY. Diagnostic test accuracy meta-analysis of PRE-DELIRIC (PREdiction of DELIRium in ICu patients): A delirium prediction model in intensive care practice. Intensive Crit Care Nurs 2020; 57:102784. [DOI: 10.1016/j.iccn.2019.102784] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/09/2019] [Accepted: 12/04/2019] [Indexed: 11/27/2022]
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van den Boogaard M, Tilburgs B. Can we accurately predict ICU delirium? Intensive Crit Care Nurs 2020; 57:102809. [PMID: 32029381 DOI: 10.1016/j.iccn.2020.102809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mark van den Boogaard
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Health Science, Geert Grooteplein Zuid 10, (Internal Post 710) 6525GA, Nijmegen, the Netherlands.
| | - Bram Tilburgs
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Health Science, Geert Grooteplein Zuid 10, (Internal Post 710) 6525GA, Nijmegen, the Netherlands
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