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Collet MO, Nielsen AH, Larsen LK, Laerkner E, Jensen JF, Mortensen CB, Lehmkuhl L, Thorn L, Rossen BS, Nielsen TA, Laursen E, Shiv LH, Villumsen M, Rahr MN, Svenningsen H. Delirium and delirium severity screening in the intensive care-correspondence of screenings tools. Aust Crit Care 2024; 37:407-413. [PMID: 37438182 DOI: 10.1016/j.aucc.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/21/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Delirium severity scores are gaining acceptance for measuring delirium in the intensive care unit (ICU). OBJECTIVE The aim of this study was to evaluate the concordance between the Confusion Assessment Method for the intensive care unit (CAM-ICU)-7 and the Intensive Care Delirium Screening Checklist (ICDSC) as delirium severity measurement tools. METHODS This was a prospective, comparative, observational multicentre study. This study was conducted in 18 Danish ICUs. Delirium was assessed in adult critically ill patients admitted to an ICU with a Richmond Agitation and Sedation Score (RASS) of -2 or above. ICU nurses assessed delirium with randomised paired delirium screening instruments, using the CAM-ICU, the ICDSC, and the CAM-ICU-7. The correlation between the CAM-ICU-7 and the ICDSC severity scores was evaluated for all predefined patient subgroups. RESULTS A total of 1126 paired screenings were conducted by 127 ICU nurses in 850 patients. The patients' median age was 70 years (interquartile range: 61-77), 40% (339/850) were female, and 54% (457/850) had at least one positive delirium score. Delirium severity ranges (CAM-ICU-7: 0-7; and ICDSC: 0-8) were positively correlated (Pearson's correlation coefficient, r = 0.83; p < 0.0001). The overall agreement between the CAM-ICU-7 and the ICDSC for delirium measurement (CAM-ICU-7: >2, and ICDSC: >3) was substantial (kappa = 0.74), but the agreement decreased to fair (kappa = 0.38) if a patient had a RASS less than 0. CONCLUSIONS The agreement between the CAM-ICU-7 and the ICDSC for delirium severity measurement was substantial but might be affected by the patient's sedation and agitation level at the time of assessment. IMPLICATIONS FOR PRACTICE Both CAM-ICU-7 and ICDSC can be implemented for delirium severity measurement. Attention is warranted in both scores if a patient has a RASS of -2.
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Affiliation(s)
- Marie O Collet
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Anne H Nielsen
- Department of Anaesthesiology and Intensive Care, Goedstrup Hospital, Denmark AND Department of Clinical Medicine, Aarhus University, Denmark
| | - Laura K Larsen
- Department of Neuroanaesthesiology, Neurointensive Care Unit 6021, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Eva Laerkner
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Denmark
| | - Janet Froulund Jensen
- Department of Neurology, Zealand University Hospital, Region Zealand, Roskilde, Denmark; Department of Anesthesiology, Holbaek Hospital, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Camilla B Mortensen
- Department of Anaesthesiology, Intensive Care Unit, Zealand University Hospital, Koege, Denmark
| | - Lene Lehmkuhl
- Department of Anaesthesiology and Intensive Care, OUH Svendborg Hospital, Svendborg, Denmark
| | - Linette Thorn
- Department of Intensive Care, Aarhus University Hospital, Denmark
| | - Birgitte Sonne Rossen
- Department of Intensive Care Y13, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Edel Laursen
- Department of Anaesthesiology and Intensive Care, Horsens Regional Hospital, Denmark
| | - Louise Hvid Shiv
- Department of Intensive Care, North Zealand Hospital, Dyrhavevej 29, 3400 Hillerød, Denmark
| | | | - Mette Nygaard Rahr
- Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Denmark
| | - Helle Svenningsen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, Programme for Physical and Mental Health, VIA University College, Campus Aarhus N, Denmark
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Nielsen AH, Larsen LK, Collet MO, Lehmkuhl L, Bekker C, Jensen JF, Laerkner E, Nielsen TA, Rossen BS, Thorn L, Laursen E, Fischer S, Villumsen M, Shiv LH, Høgh M, Rahr MN, Svenningsen H. Intensive care unit nurses' perception of three different methods for delirium screening: A survey (DELIS-3). Aust Crit Care 2023; 36:1035-1042. [PMID: 36774292 DOI: 10.1016/j.aucc.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/06/2022] [Accepted: 12/09/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Delirium is common in critically ill patients with detrimental effects in terms of increased morbidity, mortality, costs, and human suffering. Delirium detection and management depends on systematic screening for delirium, which can be challenging to implement in clinical practice. OBJECTIVES The aim of this study was to explore how nurses in the intensive care unit perceived the use of Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), the Confusion Assessment Method for the Intensive Care Unit-7 (CAM-ICU-7), and Intensive Care Delirium Screening Checklist (ICDSC) for delirium screening of patients in the intensive care unit. METHODS This was a cross-sectional, electronic-based survey of nurses' perceptions of delirium screening with the three different instruments for delirium screening. Nurses were asked to grade their perception of the usability of the three instruments and how well they were perceived to detect delirium and delirium symptom changes on a 1- to 6-point Likert scale. Open questions about perceived advantages and disadvantages of each instrument were analysed using the framework method. RESULTS One hundred twenty-seven of 167 invited nurses completed the survey and rated the CAM-ICU-7 as faster and easier than the ICDSC, which was more nuanced and reflected changes in the patient's delirium better. Despite being rated as the fastest, easiest, and most used, the CAM-ICU provided less information and was considered inferior to the CAM-ICU-7 and ICDSC. Using familiar instruments made delirium screening easier, but being able to grade and nuance the delirium assessment was experienced as important for clinical practice. CONCLUSIONS Both the ICDSC and the CAM-ICU-7 were perceived well suited for detection of delirium and reflected changes in delirium intensity. The CAM-ICU was rated as fast and easy but inferior in its ability to grade and nuance the assessment of delirium. Emphasis on clinical meaningfulness and continued education in delirium screening are necessary for adherence to delirium management guidelines.
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Affiliation(s)
- Anne Højager Nielsen
- Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Hospitalsparken 15, 7400 Herning, Denmark; Institute for Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
| | - Laura Krone Larsen
- Department of Anaesthesia and Intensive Care 6021, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - Marie Oxenbøll Collet
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - Lene Lehmkuhl
- Department of Anesthesiology and Intensive Care Medicine, OUH Svendborg Hospital, Baagøes Alle 15, 5700 Svendborg, Denmark.
| | - Camilla Bekker
- Department of Anaesthesiology and Intensive Care Medicine, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark.
| | - Janet Froulund Jensen
- Department of Neurology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark; Department of Anesthesiology, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark.
| | - Eva Laerkner
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Tina Allerslev Nielsen
- Department of Anaesthesiology and Intensive Care, Viborg Regional Hospital, Banevejen 7C, 8800 Viborg, Denmark.
| | - Birgitte Sonne Rossen
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Glostrup Valdemar Hansensvej 13, 2600 Glostrup, Denmark.
| | - Linette Thorn
- Department of Intensive Care, Aarhus University Hospital, AUH, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark.
| | - Edel Laursen
- Department of Anaesthesiology and Intensive Care, Horsens Regional Hospital, Sundvej 30, 8700 Horsens, Denmark.
| | - Susanne Fischer
- Department of Anaesthesiology and Intensive Care, Sydvestjysk Sygehus Esbjerg, Finsensgade 35, 6700 Esbjerg, Denmark.
| | - Marianne Villumsen
- Department of Anaesthesiology and Intensive Care, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NØ, Denmark.
| | - Louise Hvid Shiv
- Department of Intensive Care, North Zealand Hospital, Dyrhavevej 29, 3400 Hillerød, Denmark.
| | - Marianne Høgh
- Department of Intensive Care, Vejle Hospital, Beriderbakken 4, 7100 Vejle, Denmark.
| | - Mette Nygaard Rahr
- Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Hospitalsparken 15, 7400 Herning, Denmark.
| | - Helle Svenningsen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, Programme for Physical and Mental Health, VIA University College, Campus Aarhus N, Hedeager 2, 8200 Aarhus N, Denmark.
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