CAM-ICU and ICDSC Agreement in Medical and Surgical ICU Patients Is Influenced by Disease Severity

Fagundes, Jorge Alberto de Oliveira; Tomasi, Cristiane Damiani; Giombelli, Vinícius Renê; Alves, Sarah Cascaes; Macedo, Roberta Candal de; Topanotti, Maria Fernanda Locks; Bristot, Maria de Lourdes Ugioni; Brasil, Pedro Emmanuel Alvarenga Americano do; Soares, Márcio; Salluh, Jorge I.; Dal‐Pizzol, Felipe; Ritter, Cristiane

doi:10.1371/journal.pone.0051010

Cited by 20 publications

(11 citation statements)

References 21 publications

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“…Likewise, the κ coefficient of the ICDSC had a wide range in the literature. It was low or moderate in some studies (Domenico & Federica, 2012;Neufeld et al, 2011;Tomasi et al, 2012), while high and excellent in others (Devlin et al, 2007;George et al, 2011;Plaschke et al, 2008).…”

Section: Reliability-kappa Coefficient (κ)mentioning

confidence: 87%

“…The specificity was 95 (87-98) in a study performed in the Netherlands (van Eijk et al, 2009). The sensitivity and specificity values of the ICDSC were different in various studies because these studies were performed in different ICUs and countries (Tomasi et al, 2012). We assumed that the difference between the surgical and medical ICUs might be related to sociodemographic characteristics of the patients, comorbid factors, and the severity of the disease.…”

Section: Validitymentioning

confidence: 99%

“…Moreover, these instruments are easy to use. They can be administered by health professionals who are not specialists in psychiatry, such as ICU nurses (Devlin et al, 2007;Fagundes et al, 2012;Guenther & Radtke, 2011;Neufeld et al, 2011).…”

mentioning

confidence: 99%

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Reliability and Validity of the Intensive Care Delirium Screening Checklist in Turkish

Köse

Bolu

Özdemir

et al. 2015

Int J of Nursing Knowl

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Section: Reliability-kappa Coefficient (κ)mentioning

confidence: 87%

Section: Validitymentioning

confidence: 99%

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Reliability and Validity of the Intensive Care Delirium Screening Checklist in Turkish

Köse

Bolu

Özdemir

et al. 2015

Int J of Nursing Knowl

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“…First, it employs senescent mice equivalent to human subjects 60 to 70 years old (Dutta and Sengupta, 2016;The Jackson Laboratory,, 2017), i.e., ages associated with greater risk of POD (Inouye, 2006;Deiner and Silverstain, 2009;Ansaloni et al, 2010;Wang et al, 2016). Second, the methods used to test the animals are consistent with the ICU-Confusion Assessment Method (ICU-CAM), a widely used ICU algorithm (Ely et al, 2001;Pandharipande et al, 2007;Fagundes et al, 2012;Gusmao-Flores et al, 2012;Peng et al, 2016) that evaluates key aspects of delirium, i.e., acute onset and fluctuating course, inattention, and disorganized thinking. Third, compared to previous studies (Murray et al, 2012;Culley et al, 2014;Ren et al, 2015;Peng et al, 2016), our model uses multiple behavioral tests and shorter intervals between assessments to capture the acute and fluctuating nature of POD.…”

Section: Discussionmentioning

confidence: 99%

Surgery, Anesthesia and Intensive Care Environment Induce Delirium-Like Behaviors and Impairment of Synaptic Function-Related Gene Expression in Aged Mice

Illendula

Osuru

Ferrarese

et al. 2020

Front. Aging Neurosci.

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To establish a clinically relevant mouse model of perioperative delirium. Methods: Aged C57BL/6J mice were tested at baseline in the Y-maze novel arm preference, buried food, simple discrimination task of the attentional set-shifting test, and open field tests. They were subsequently randomized to insult (anesthesia, surgery, and Intensive Care Unit environment) or control group. Insult-exposed mice received laparotomy under sevoflurane anesthesia, propofol sedation and exposure to intermittent lights, sounds and cage shaking. Controls did not receive anesthesia, surgery, or intensive care environment. All mice were tested in the Y-maze novel arm preference, buried food, attentional, and open field tests at the end of intensive care environment (0 h) and every 6 h up to 24 h. Mouse hippocampi were collected at 24 h for gene expression analyses. Results: Surgery, anesthesia and Intensive Care environment decreased the entries in the Y-maze novel arm at 0 h (P = 0.001), 6 h (P < 0.001), 18 h (P = 0.002), and 24 h (P = 0.029). Insult exposure increased the latency to find a buried cereal reward at 18 h (P = 0.035) and 24 h (P = 0.027), and increased the trials to criterion in the reverse compound discrimination (P = 0.013) and extradimensional shift (P < 0.001) tasks of the attentional test. The overall incidence of delirium was 72% in A/S/I mice. Messenger RNA levels of synuclein alpha (−3.785 fold change relative to controls), Neurotrophic Receptor Tyrosine Kinase1 (−2.267), and syntaxin1a (−1.498) were decreased in the hippocampus of mice 24 h after insult exposure. Protein levels of syntaxin 1a (P = 0.012), Neurotrophic Receptor Tyrosine Kinase1 (P = 0.039), synuclein alpha (P = 0.017), phosphorylated synuclein alpha (P = 0.008), synaptophysin (P = 0.002), postsynaptic density protein 95 (P = 0.003), and microtubule-associated protein 2 (P = 0.013) were also decreased, relative to controls. Conclusion: Surgery, anesthesia and Intensive Care environment impaired mouse behaviors that depend on attention, memory, and thought organization. The changes

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“…Previous studies compare the CAM-ICU and ICDSC as measures of delirium presence or absence and with high agreement [7][8][9][10][11]. The CAM-ICU and ICDSC have different approaches.…”

Section: Introductionmentioning

confidence: 99%

The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients

et al. 2020

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Background In clinical practice, a dichotomous approach to delirium identification may no longer be relevant when existing delirium screening tools measure a range of scores. The objective of this study was to compare the Confusion Assessment Method for the Intensive Care Unit 7-item (CAM-ICU-7) and the Intensive Care Delirium Screening Checklist (ICDSC) as measures of the spectrum of delirium severity in critically ill adult patients. Methods In this cross-sectional study, 218 patients underwent 641 paired assessments by bedside nurses (ICDSC, as per usual care) and trained research assistants (CAM-ICU-7). Correlation between the CAM-ICU-7 and ICDSC scores was evaluated. Logistic regression was used to explore associations between CAM-ICU-7 or ICDSC score and length of ICU stay and mechanical ventilation (receipt, ≥96 hours). Results Delirium prevalence evaluated by the CAM-ICU-7 and ICDSC were 46.3% (95% CI:39.7–53.0) and 34.4% (95% CI:28.3–41.0). Prevalence of less than clinical threshold symptoms of delirium evaluated by the CAM-ICU-7 (score: 1–2) and ICDSC (score: 1–3) were 30.3% (95%CI:24.5–36.7) and 50.9% (95%CI:44.3–57.6). The CAM-ICU-7 and ICDSC had significant positive correlation (0.58, p<0.001). Agreement between the tools as measures of delirium was moderate (kappa = 0.51) and as measures of less than clinical threshold symptoms of delirium was fair (kappa = 0.21). Less than clinical threshold symptoms of delirium identified by the ICDSC, not CAM-ICU-7, were associated with prolonged length of ICU stay (≥7 days) in patients <65 years of age [Odds Ratio (OR) 9.2, 95% CI:2.5–34.0] and mechanical ventilation (receipt: OR 2.8, 95% CI:1.3–6.4; ≥96 hours: OR 6.6, 95% CI:1.9–22.9), when compared to patients with no delirium. Conclusions The CAM-ICU-7 and ICDSC are measures of the spectrum of delirium severity that are closely correlated. Less than clinical threshold symptoms of delirium measure by the ICDSC is a better predictor of outcomes, when compared with the CAM-ICU-7.

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CAM-ICU and ICDSC Agreement in Medical and Surgical ICU Patients Is Influenced by Disease Severity

Cited by 20 publications

References 21 publications

Reliability and Validity of the Intensive Care Delirium Screening Checklist in Turkish

Reliability and Validity of the Intensive Care Delirium Screening Checklist in Turkish

Surgery, Anesthesia and Intensive Care Environment Induce Delirium-Like Behaviors and Impairment of Synaptic Function-Related Gene Expression in Aged Mice

The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients

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