A Research Algorithm to Improve Detection of Delirium in the Intensive Care Unit
DSpace/Manakin Repository
A Research Algorithm to Improve Detection of Delirium in the Intensive Care Unit
| Title: | A Research Algorithm to Improve Detection of Delirium in the Intensive Care Unit |
| Author: |
Pisani, Margaret A; Araujo, Katy LB; Van Ness, Peter H; Ely, E Wesley; Zhang, Ying; Inouye, Sharon
Note: Order does not necessarily reflect citation order of authors. |
| Citation: | Pisani, Margaret A., Katy L. B. Araujo, Peter H. Van Ness, Ying Zhang, E. Wesley Ely, and Sharon K. Inouye. 2006. A research algorithm to improve detection of delirium in the intensive care unit. Critical Care 10(4): R121. |
| Full Text & Related Files: |
1750978.pdf (146.3Kb; PDF) 
|
| Abstract: | Introduction: Delirium is a serious and prevalent problem in intensive care units (ICUs). The purpose of this study was to develop a research algorithm to enhance detection of delirium in critically ill ICU patients using chart review to complement a validated clinical delirium instrument. Methods: A prospective cohort study was conducted in 178 patients aged 60 years and older who were admitted to the medical ICU. The Confusion Assessment Method for the ICU (CAM-ICU) and a validated chart review method for detecting delirium were performed daily. We assessed the diagnostic accuracy of the chart-based delirium method using the CAM-ICU as the 'gold standard'. We then used an algorithm to detect delirium first using the CAM-ICU ratings and then chart review when the CAM-ICU was unavailable. Results: When using both the CAM-ICU and the chart-based review, the prevalence of delirium was found to be 80% of patients (143 out of 178) or 64% of patient-days (929 out of 1,457). Of these patient-days, 292 were classified as delirium by the CAM-ICU. The remainder (637 patient-days) were classified as delirium by the validated chart review method when CAM-ICU was missing because the assessment was conducted for weekends or holidays (404 patient-days), when CAM-ICU was not performed because of stupor or coma (205 patient-days), and when the CAM-ICU was negative (28 patient-days). Sensitivity of the chart-based method was 64% and specificity was 85%. Overall agreement between chart and the CAM-ICU was 72%. Conclusion: Eight out of 10 patients in this cohort study developed delirium in the ICU. Although use of a validated delirium instrument with frequent direct observations is recommended for clinical care, this approach may not always be feasible, especially in a research setting. The algorithm proposed here comprises a more comprehensive method for detecting delirium in a research setting, taking into account the fluctuation that occurs with delirium, which is a key component of accurate determination of delirium status. Improving detection of delirium is of paramount importance both to advance delirium research and to enhance clinical care and patient safety. |
| Published Version: | doi:10.1186/cc5027 |
| Other Sources: | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1750978/pdf/ |
| Terms of Use: | This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA |
| Citable link to this page: | http://nrs.harvard.edu/urn-3:HUL.InstRepos:4878058 |
This item appears in the following Collection(s)
-
HMS Scholarly Articles [4000]
Contact administrator regarding this item (to report mistakes or request changes)
