Current status of delirium assessment tools in the intensive care unit: a prospective multicenter observational survey

Abstract

Delirium is a critical challenge in the intensive care unit (ICU) or high care unit (HCU) setting and is associated with poor outcomes. There is not much literature on how many patients in this setting are assessed for delirium and what tools are used. This study investigated the status of delirium assessment tools of patients in the ICU/HCU. We conducted a multicenter prospective observational study among 20 institutions. Data for patients who were admitted to and discharged from the ICU/HCU during a 1-month study period were collected from each institution using a survey sheet. The primary outcome was the usage rate of delirium assessment tools on an institution- and patient-basis. Secondary outcomes were the delirium prevalence assessed by each institution’s assessment tool, comparison of delirium prevalence between delirium assessment tools, delirium prevalence at the end of ICH/HCU stay, and the relationship between potential factors related to delirium and the development of delirium. Result showed that 95% of institutions used the Intensive Care Delirium Screening Checklist (ICDSC) or the Confusion Assessment Method for the ICU (CAM-ICU) to assess delirium in their ICU/HCU, and the remaining one used another assessment scale. The usage rate (at least once during the ICU/HCU stay) of the ICDSC and the CAM-ICU among individual patients were 64.5% and 25.1%, and only 8.2% of enrolled patients were not assessed by any delirium assessment tool. The prevalence of delirium during ICU/HCU stay was 17.9%, and the prevalence of delirium at the end of the ICU/HCU stay was 5.9%. In conclusion, all institutions used delirium assessment tools in the ICU/HCU, and most patients received delirium assessment. The prevalence of delirium was 17.9%, and two-thirds of patients had recovered at discharge from ICU/HCU.Trial registration number: UMIN000037834.

Level of Delirium and its Contributing Factor among Patients in ICU

“…The four studies included only surgical patients. [15] Four studies used the Intensive Care Delirium Screening Checklist (ICDSC) and two confusion assessment (CAM) scores to diagnose SSDs. The use of antipsychotics in SSD patients to prevent delirium was evaluated in two studies but it did not modify ICU LOS.…”

Diagnosing delirium in perioperative and intensive care medicine

“…The CAM, DOSS, DRS-98, and MDAS are frequently used and well validated instruments that are at least partially consistent with the current diagnostic framework (DSM-5) for delirium [25]. In the ICU, 95% of institutions report using the ICDSC or the CAM-ICU [103 ▪ ]. However, a previous diagnostic meta-analysis examined and compared the accuracy of the CAM-ICU and the ICDSC against reference standards.…”

Anesthetic Management Using Remimazolam for Transcatheter Edge-to-Edge Repair of the Mitral Valve in Patients With Reduced Ejection Fraction: A Case Report of Two Cases

“…Clinical research on the impact of remimazolam on postoperative delirium is still ongoing [9]. In both cases, the commonly used delirium assessment score, ICDSC, was 0 [10]. Thus, they were diagnosed with no symptoms suspicious of delirium.…”