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Delirium Screening in Neurocritical Care and Stroke Unit Patients: A Pilot Study on the Influence of Neurological Deficits on CAM-ICU and ICDSC Outcome
- Source :
- Neurocritical Care
- Publication Year :
- 2020
- Publisher :
- Springer US, 2020.
-
Abstract
- Background/Objective Delirium is a common complication in critically ill patients with a negative impact on hospital length of stay, morbidity, and mortality. Little is known on how neurological deficits affect the outcome of commonly used delirium screening tools such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) in neurocritical care patients. Methods Over a period of 1 month, all patients admitted to a neurocritical care and stroke unit at a single academic center were prospectively screened for delirium using both CAM-ICU and ICDSC. Tool-based delirium screening was compared with delirium evaluation by the treating clinical team. Additionally, ICD-10 delirium criteria were assessed. Results One hundred twenty-three patients with a total of 644 daily screenings were included. Twenty-three patients (18.7%) were diagnosed with delirium according to the clinical evaluation. Delirium incidence amounted to 23.6% (CAM-ICU) and 26.8% (ICDSC). Sensitivity and specificity of both screening tools were 66.9% and 93.3% for CAM-ICU and 69.9% and 93.9% for ICDSC, respectively. Patients identified with delirium by either CAM-ICU or ICDSC presented a higher proportion of neurological deficits such as impaired consciousness, expressive aphasia, impaired language comprehension, and hemineglect. Subsequently, generalized estimating equations identified a significant association between impaired consciousness (as indexed by Richmond Agitation and Sedation Scale) and a positive delirium assessment with both CAM-ICU and ICDSC, while impaired language comprehension and hemineglect were only associated with a positive CAM-ICU result. Conclusions A positive delirium screening with both CAM-ICU and ICDSC in neurocritical care and stroke unit patients was found to be significantly associated with the presence of neurological deficits. These findings underline the need for a more specific delirium screening tool in neurocritical care patients.
- Subjects :
- Male
medicine.medical_specialty
Neurology
ICDSC
Critical Care
Pilot Projects
Critical Care and Intensive Care Medicine
behavioral disciplines and activities
law.invention
03 medical and health sciences
0302 clinical medicine
law
Intensive care
mental disorders
medicine
Neurocritical care
Humans
030212 general & internal medicine
Stroke
business.industry
Incidence (epidemiology)
CAM-ICU
Neurointensive care
Delirium
medicine.disease
Prognosis
Intensive care unit
nervous system diseases
Checklist
Intensive Care Units
Expressive aphasia
Emergency medicine
Female
Neurology (clinical)
medicine.symptom
business
030217 neurology & neurosurgery
Original Work
Subjects
Details
- Language :
- English
- ISSN :
- 15560961 and 15416933
- Volume :
- 33
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Neurocritical Care
- Accession number :
- edsair.doi.dedup.....b573b001e68c2d174fa2548144038037