Sensitivity and specificity of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for detecting post-cardiac surgery delirium: A single-center study in Japan

Nishimura, Kazuhiko; Yokoyama, Kanako; Yamauchi, Noriko; Koizumi, Masako; Harasawa, Nozomi; Yasuda, Taeko; Mimura, Chizuru; Igita, Hazuki; Suzuki, Eriko; Uchiide, Yoko; Seino, Yusuke; Nomura, Masatoshi; Yamazaki, Kenji; Ishigooka, Jun

doi:10.1016/j.hrtlng.2015.11.001

Cited by 56 publications

(30 citation statements)

References 31 publications

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“…Therefore, we cannot preclude the potential bias produced by imbalance of these factors. Lastly, it has been noted that CAM-ICU might not be as sensitive as other tools, eg, 3D-CAM, for delirium assessment especially for other ethnic groups 50,51 and in non-ICU settings. 52 Our study indicates that, in elderly patients admitted to the ICU after non-cardiac surgery, prophylactic low-dose dexmedetomidine infusion signifi cantly decreases the prevalence of postoperative delirium.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial

et al. 2016

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“…Our cohort is representative of other adult ICU populations, reflected by median age [6, 10, 11, 24, 38], distribution of gender, the SAPS II [24, 38], the duration of delirium [39], the Charlson Comorbidity Index [10, 11, 38], the proportion of patients with mechanical ventilation [10, 24], ICU stay [10, 38] being similar to prior studies of delirium in ICU patients. However, mortality was higher in our cohort as compared to international epidemiological multicenter studies of delirium [10, 38], possibly indicating an intensifying effect on mortality by the concurrence of BSI and the genesis of delirium.…”

Section: Discussionmentioning

confidence: 99%

“…Both have been equally recommended for the screening of delirium in ICUs by the Society of Critical Care Medicine Pain, Agitation, and Delirium guidelines based on high-quality evidence [21]. Direct comparisons of the diagnostic accuracy of the CAM-ICU and the ICDSC have been performed in recent studies with heterogenous ICU populations revealing a higher sensitivity and specificity of the ICDSC than the CAM-ICU [22–24]. The indications for the placement of catheters and drainages may be related to the development of delirium in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for new-onset delirium in patients with bloodstream infections: independent and quantitative effect of catheters and drainages—a four-year cohort study

Dittrich

Tschudin‐Sutter

Widmer

et al. 2016

Ann. Intensive Care

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BackgroundBloodstream infections (BSI) and delirium are frequent in critically ill patients. During systemic inflammatory response to BSI, cytokines may interact with neurotransmitters and neuronal receptors driving acute brain dysfunction. However, prospectively collected data on incidence, prediction and impact of delirium in association with BSI are lacking. This study aimed to determine the incidence and predictors of new-onset delirium and its impact on outcome in critically ill adult patients with BSI.MethodsFrom 2011 to 2014, all consecutive adult patients with BSI treated in the intensive care units of an academic medical care center were identified. Pertinent clinical and microbiological data including the Intensive Care Delirium Screening Checklist (ICDSC) were assessed. Multivariable analysis was performed to identify variables independently associated with ICDSC ≥4.ResultsAmong 240 patients, 145 (60%) had an ICDSC ≥4 (i.e., delirium). In-hospital mortality was 34%. Delirious patients had a higher mortality (40 vs. 23%; p = 0.005), a lower proportion with return to functional baseline (30 vs. 46%; p = 0.012), and a higher proportion with unfavorable outcome in survivors (74 vs. 54%; p = 0.010). Multivariable analyses revealed age (OR 1.04, 95% CI 1.02–1.06), male gender (OR 2.26, 95% CI 1.17–4.36), and the number of catheters and drainages before diagnosis of BSI (OR for every additional catheter = 1.14, 95% CI 1.04–1.25) as independent predictors for delirium (adjusted for SAPS [simplified acute physiology score] II, Riker Sedation-Agitation Scale [SAS], Sequential Organ Failure Assessment [SOFA] score, dementia and/or leukoencephalopathy, and albumin levels).ConclusionsThe incidence of delirium in patients with BSI is high and associated with adverse outcome. The number of catheters and drainages may constitute a useful and readily available predictor of delirium in patients with BSI allowing to identify patients at high risk. Ultimately, reliable identification of patients at increased risk for delirium is key for allocation of specific prevention strategies.

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“…These tools have been reported to be ineffective and have poor sensitivity (38% to 47%) in busy hospital environments, such as those in an intensive care unit (ICU). 15,16 Electroencephalography (EEG) is highly useful in detecting delirium. 17,18 However, it is not practical or timely for screening the high volume of elderly patients admitted.…”

Section: Elirium In Hospitalized Elderly Patientsmentioning

confidence: 99%

“…Although, these instruments have been shown to be sensitive and specific in research settings, the frequency with which these tools must be administered and their subjective nature make them impractical for use in real‐world hospital workflows. These tools have been reported to be ineffective and have poor sensitivity (38% to 47%) in busy hospital environments, such as those in an intensive care unit (ICU) …”

mentioning

confidence: 99%

Delirium detection by a novel bispectral electroencephalography device in general hospital

Shinozaki

Chan

Sparr

et al. 2018

Psychiatry Clin Neurosci

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Aim: Delirium is common and dangerous among elderly inpatients; yet, it is underdiagnosed and thus undertreated. This study aimed to test the diagnostic characteristics of a noninvasive point-of-care device with two-channel (bispectral) electroencephalography (EEG) for the screening of delirium in the hospital. Methods: Patients admitted to the University of Iowa Hospitals and Clinics were assessed for the presence of delirium with a clinical assessment, the Confusion Assessment Method for Intensive Care Unit and Delirium Rating Scale. Subsequently, we obtained a 10-min bispectral EEG (BSEEG) recording from a hand-held electroencephalogram device during hospitalization. We performed power spectral density analysis to differentiate between those patients with and without delirium. Results: Initially 45 subjects were used as a test dataset to establish a cut-off. The BSEEG index was determined to be a significant indicator of delirium, with sensitivity 80% and specificity 87.7%. An additional independent validation dataset with 24 patients confirmed the validity of the approach, with a sensitivity of 83.3% and specificity of 83.3%. Conclusion: In this pilot study, the BSEEG method was able to distinguish delirious patients from non-delirious patients. Our data showed the feasibility of this technology for mass screening of delirium in the hospital.

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Sensitivity and specificity of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for detecting post-cardiac surgery delirium: A single-center study in Japan

Cited by 56 publications

References 31 publications

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial

Risk factors for new-onset delirium in patients with bloodstream infections: independent and quantitative effect of catheters and drainages—a four-year cohort study

Delirium detection by a novel bispectral electroencephalography device in general hospital

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