Comparison of CAM-ICU and ICDSC for the detection of delirium in critically ill patients focusing on relevant clinical outcomes

Tomasi, Cristiane Damiani; Grandi, Carmen; Salluh, Jorge I.; Soares, Márcio; Giombelli, Vinícius Renê; Cascaes, Sarah; Macedo, Roberta Candal de; Constantino, Larissa; Biff, Daiane; Ritter, Cristiane

doi:10.1016/j.jcrc.2011.05.015

Cited by 77 publications

(56 citation statements)

References 21 publications

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“…, CAM-ICU vs. ICDSC) given evidence suggesting that the sensitivity and specificity of these two instruments may differ (5, 26, 27); 2) the predominate ICU service that the patient was admitted to (i.e., medical versus surgical); 3) the presence of delirium at the time of enrollment in some or all patients versus the presence of delirium in none; 4) patients at low risk for mortality (≤5%) versus those at high risk for mortality (≥10%); 5) patients administered a pharmacological intervention versus those administered a non-pharmacological intervention; and 6) among patients administered a pharmacological intervention, those administered antipsychotic versus an alpha-2 receptor agonist (e.g. , clonidine or dexmedetomidine) or an acetylcholinesterate inhibitor (e.g., rivastigmine).…”

Section: Methodsmentioning

confidence: 99%

Randomized ICU Trials Do Not Demonstrate an Association Between Interventions That Reduce Delirium Duration and Short-Term Mortality

Al-Qadheeb

Balk

Fraser

et al. 2014

Critical Care Medicine

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Background Interventions that reduce delirium duration may also lower short-term mortality. We reviewed randomized trials of adult ICU patients of interventions hypothesized to reduce delirium burden to determine whether interventions that are more effective at reducing delirium duration are associated with a reduction in short-term mortality. Search Methods We searched CINHAHL, EMBASE, MEDLINE and the Cochrane databases from 2001 through 2012. Citations were screened for randomized trials that enrolled critically ill adults, evaluated delirium at least daily, compared a drug or non-drug intervention hypothesized to reduce delirium burden with standard care (or control), and reported delirium duration and/or short-term mortality (≤45 days). In duplicate, we abstracted trial characteristics and results and evaluated quality using the Cochrane risk of bias tool. We performed random effects model meta-analyses and meta-regressions. Results We included 17 trials enrolling 2,849 patients which evaluated a pharmacologic intervention (n=13) [dexmedetomidine (n=6); an antipsychotic (n=4); rivastigmine (n=2); and clonidine (n=1)], a multimodal intervention (n=2) [spontaneous-awakening (n=2)]; or a non-pharmacologic intervention (n=2) [early mobilization (n=1); increased perfusion (n=1)]. Overall, average delirium duration was lower in the intervention groups [difference = −0.64 days; 95% CI, −1.15 to −0.13; P = 0.01) being reduced by ≥3 days in 3 studies, 0.1 to < 3 days in 6 studies, 0 days in 7 studies and < 0 days in 1. Across interventions, for 13 studies where short-term mortality was reported, short-term mortality was not reduced (risk ratio = 0.90; 95% CI, 0.76 to 1.06; P = 0.19). Across 13 studies that reported mortality, meta-regression revealed that delirium duration was not associated with reduced short-term mortality (P = 0.11). Conclusions A review of current evidence fails to support that ICU interventions that reduce delirium duration reduce short-term mortality. Larger controlled studies are needed to establish this relationship.

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Section: Methodsmentioning

confidence: 99%

Randomized ICU Trials Do Not Demonstrate an Association Between Interventions That Reduce Delirium Duration and Short-Term Mortality

Al-Qadheeb

Balk

Fraser

et al. 2014

Critical Care Medicine

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show abstract

“…Thus, this drawback (of ICDSC) may affect the outcome of the present results. However, a recent study by Tomasi et al (2012), which is a singlecentre study, showed relatively low delirium rates assessed by ICDSC, implying that these current results must be confirmed by multicenter studies, including larger populations. Fourthly, only cognitive screening test (MMSE) was used in the present study.…”

Section: Limitations and Future Directionsmentioning

confidence: 59%

“…Secondly, the study was based on a small sample size and was only undertaken at one academic tertiary medical centre in Japan. Thirdly, recent studies suggest that the CAM-ICU is a better predictor of outcomes than the ICDSC (Tomasi et al, 2012) for delirium in ICU patients as there might be high rates of false positives with the ICDSC (Gusmao-Flores et al, 2012). Thus, this drawback (of ICDSC) may affect the outcome of the present results.…”

Section: Limitations and Future Directionsmentioning

confidence: 75%

Severity of delirium in the ICU is associated with short term cognitive impairment. A prospective cohort study

Sakuramoto

Jesmin

Unoki

et al. 2015

Intensive and Critical Care Nursing

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“…A total ICSDC Score  4 has a 99% sensitivity correlation for a psychiatric diagnosis of delirium [24]. However, CAM-ICU is a stronger predictor of outcome compared to ICDSC [26].…”

Section: Diagnosismentioning

confidence: 99%

Altered mental status in the neurocritical care unit

Behrouz

Godoy²,

Azarpazhooh

et al. 2015

Journal of Critical Care

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Comparison of CAM-ICU and ICDSC for the detection of delirium in critically ill patients focusing on relevant clinical outcomes

Abstract: The findings of our study suggest that the CAM-ICU is better predictor of outcome when compared with ICDSC.

Cited by 77 publications

References 21 publications

Randomized ICU Trials Do Not Demonstrate an Association Between Interventions That Reduce Delirium Duration and Short-Term Mortality

Randomized ICU Trials Do Not Demonstrate an Association Between Interventions That Reduce Delirium Duration and Short-Term Mortality

Severity of delirium in the ICU is associated with short term cognitive impairment. A prospective cohort study

Altered mental status in the neurocritical care unit

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