European Journal of Anaesthesiology:
Abstracts and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Best Abstracts - Runner-up Session 1
Kavlak, E.; Dilek, A.; Ulger, F.; Arik, A. C.; Karakaya, D.; Azar, H.
Ondokuz Mayis University, School of Medicine, Department of Anaesthesiology and Intensive Care, Samsun, Turkey
Background and Goal of Study: Delirium is accepted as a common sign of acute brain dysfunction in intensive care unit (ICU) patients. An ideal delirium screening test must be performed rapidly and accurately at the bedside by nurses and staff in ICU.
In this study we aimed to compare the “The Diagnostic and Statistical Manual of Mental Disorders” (DSM‐IV), which is accepted as an international criteria for diagnosing delirium, with the “Confusion Assessment Method for the Intensive Care Unit” (CAM‐ICU), “Intensive Care Delirium Screening Checklist” (ICDSC) and Nursing Delirium Screening Scale” (Nu‐DESC) in critically ill patients.
Materials and Methods: After ethical committee approval, 70 patients who stayed in ICU for more than 48 hours and who had Richmond Sedation‐Agitation Scale (RASS) ≥ ‐3 were included into this study in a double‐blinded manner. RASS and CAM‐ICU values were assessed by a resident. These patients were also assessed by another resident with ICDSC and by an ICU nurse with Nu‐DESC.
A consulting psychiatrist also evaluated each patient for diagnosis of delirium according to DSM‐IV criteria. These four assessments were performed once for each patient, in the same period. Using the DSM‐IV, as a gold standard for delirium, the sensitivity and specificity of each test were calculated.
Results: According to DSM‐IV criteria, delirium was identified in 12 patients. Male patients experienced statistically higher delirium rate (88.3%) than female patients (16.7%). The sensitivity, specificity and predictive values of tests are shown in Table 1. APACHE II scores and length of stay in ICU were longer in delirious patients (p< 0.05). SOFA scores were similar between delirious and non‐delirious patients.
Conclusions: Our study showed that the ICDSC is the most sensitive and the Nu‐DESC is the most specific test for screening delirium. It was also shown that, the Nu‐DESC, which is designed for different clinical usages, can also be implemented successfully in the intensive care units by the intensive care nurses as well as CAM‐ICU and ICDSC, which are accepted as the standard criteria for delirium diagnosis in intensive care units.