Validation and comparison of CAM-ICU and ICDSC in mild and moderate traumatic brain injury patients

Frenette, Anne Julie; Bebawi, Emmanuel; Deslauriers, Louis C.; Tessier, Andrée-Anne L.; Perreault, Marc M.; Delisle, Marie-Soleil; Bertrand, Jean-Claude; Desjardins, Marie‐Pier; Rico, Philippe; Khwaja, Kosar; Burry, Lisa; Bernard, Francis; Williamson, David

doi:10.1007/s00134-015-3964-1

Cited by 35 publications

(34 citation statements)

References 5 publications

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“…Secondary outcome was the occurrence of altered mental status defined as either delirium or delayed awakening after discontinuation of sedation. Delayed awakening and the occurrence of delirium following discontinuation of sedation were assessed daily using the RASS and the Confusion Assessment Method in ICU (CAM-ICU), respectively [39]. Delayed awakening was defined by absence of spontaneous eye opening with RASS ≤−1 more than 3 days after discontinuation of sedation.…”

Section: Methodsmentioning

confidence: 99%

Early impairment of intracranial conduction time predicts mortality in deeply sedated critically ill patients: a prospective observational pilot study

Azabou

Rohaut

Heming

et al. 2017

Ann. Intensive Care

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BackgroundSomatosensory (SSEP) and brainstem auditory (BAEP) evoked potentials are neurophysiological tools which, respectively, explore the intracranial conduction time (ICCT) and the intrapontine conduction time (IPCT). The prognostic values of prolonged cerebral conduction times in deeply sedated patients have never been assessed. Sedated patients are at risk of developing new neurological complications, undetected. In this prospective observational bi-center pilot study, we investigated whether early impairment of SSEP’s ICCT and/or BAEP’s IPCT could predict in-ICU mortality or altered mental status (AMS), in deeply sedated critically ill patients.MethodsSSEP by stimulation of the median nerve and BAEP were assessed in critically ill patients receiving deep sedation on day 3 following ICU admission. Deep sedation was defined by a Richmond Assessment sedation Scale (RASS) <−3. Mean left- and right-side ICCT and IPCT were measured for each patient. Primary and secondary outcomes were, respectively, in-ICU mortality and AMS defined as the occurrence of delirium and/or delayed awakening after discontinuation of sedation.ResultsEighty-six patients were studied of which 49 (57%) were non-brain-injured and 37 (43%) were brain-injured. Impaired ICCT was a predictor of in-ICU mortality after adjustment on the global Sequential Organ Failure Assessment score (SOFA) [OR (95% CI) = 2.69 (1.05–6.85); p = 0.039] and on the non-neurological SOFA components [2.67 (1.05–6.81); p = 0.040]. IPCT was more frequently delayed in the subgroup of patients who developed post-sedation AMS (24%) compared those without AMS (0%). However, this difference did not reach statistical significance (p = 0.053). Impairment rates of ICCT and IPCT were not found to be significantly different between non-brain- and brain-injured subgroups of patients.ConclusionIn critically ill patients receiving deep sedation, early ICCT impairment was associated with mortality. Somatosensory and brainstem auditory evoked potentials may be useful early warning indicators of brain dysfunction as well as prognostic markers in deeply sedated critically ill patients.

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Section: Methodsmentioning

confidence: 99%

Early impairment of intracranial conduction time predicts mortality in deeply sedated critically ill patients: a prospective observational pilot study

Azabou

Rohaut

Heming

et al. 2017

Ann. Intensive Care

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“…The study was conducted over a period of 31 consecutive days (May 8 to June 7, 2017), representing a 1-month sample. As delirium incidence was unknown, sample size estimates were based on previous works that have studied delirium in stroke or neurocritical care [16,18]. We estimated that a group size of some 100 patients with an expected delirium incidence of 20-26% [21] was required.…”

Section: Population and Settingmentioning

confidence: 99%

“…In one general intensive care cohort in the Netherlands, a specificity of only 17% in a mixed neurological/neurosurgical sub-cohort of 34 patients tested with CAM-ICU was reported [17]. In patients with mild to moderate traumatic brain injury, delirium was present in 45.9% of patients, but comparably low sensitivity and specificity for both tests were reported with 62% and 64% for CAM-ICU screening and 64% and 79% for ICDSC screening, respectively [18]. In 151 patients with ischemic or hemorrhagic stroke, subarachnoid hemorrhage, or cerebral tumors [19], delirium was diagnosed in 14% of patients according to ICDSC.…”

Section: Introductionmentioning

confidence: 99%

Delirium Screening in Neurocritical Care and Stroke Unit Patients: A Pilot Study on the Influence of Neurological Deficits on CAM-ICU and ICDSC Outcome

et al. 2020

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Background/Objective: Delirium is a common complication in critically ill patients with a negative impact on hospital length of stay, morbidity, and mortality. Little is known on how neurological deficits affect the outcome of commonly used delirium screening tools such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) in neurocritical care patients. Methods: Over a period of 1 month, all patients admitted to a neurocritical care and stroke unit at a single academic center were prospectively screened for delirium using both CAM-ICU and ICDSC. Tool-based delirium screening was compared with delirium evaluation by the treating clinical team. Additionally, ICD-10 delirium criteria were assessed. Results: One hundred twenty-three patients with a total of 644 daily screenings were included. Twenty-three patients (18.7%) were diagnosed with delirium according to the clinical evaluation. Delirium incidence amounted to 23.6% (CAM-ICU) and 26.8% (ICDSC). Sensitivity and specificity of both screening tools were 66.9% and 93.3% for CAM-ICU and 69.9% and 93.9% for ICDSC, respectively. Patients identified with delirium by either CAM-ICU or ICDSC presented a higher proportion of neurological deficits such as impaired consciousness, expressive aphasia, impaired language comprehension, and hemineglect. Subsequently, generalized estimating equations identified a significant association between impaired consciousness (as indexed by Richmond Agitation and Sedation Scale) and a positive delirium assessment with both CAM-ICU and ICDSC, while impaired language comprehension and hemineglect were only associated with a positive CAM-ICU result. Conclusions: A positive delirium screening with both CAM-ICU and ICDSC in neurocritical care and stroke unit patients was found to be significantly associated with the presence of neurological deficits. These findings underline the need for a more specific delirium screening tool in neurocritical care patients.

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“…[39–41] The general construct one needs to consider is that delirium— a “micro-diffuse” injury occurring due to cellular and neurotransmitter abnormalities—can occur on top of the a “macro-focal” primary neurological injury, such as stroke or a traumatic brain injury. New baseline neurological function needs to be assessed and documented and any change or fluctuation of neurological function needs to be considered in the context of the primary brain injury or evolvement of the same.…”

Section: What Are the Major Recent Advances In Delirium Research And mentioning

confidence: 99%

“…Delirium should be considered in the differential diagnosis, given data that delirium superimposed on a primary neurological injury may portend worse outcomes. [39–41]…”

Section: What Are the Major Recent Advances In Delirium Research And mentioning

confidence: 99%

The intensive care delirium research agenda: a multinational, interprofessional perspective

et al. 2017

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Delirium, a prevalent organ dysfunctions in critically ill patients, is independently associated with increased morbidity. This last decade has witnessed an exponential growth in delirium research in hospitalized patients, including those critically ill, and this research has highlighted that delirium needs to be better understood mechanistically, to help foster research that will ultimately lead to its prevention and treatment. In this invited, evidence-based paper, a multinational and interprofessional group of clinicians and researchers from within the fields of critical care medicine, psychiatry, pediatrics, anesthesiology, geriatrics, surgery, neurology, nursing, pharmacy and the neurosciences, sought to address five questions: What is the current standard of care in managing ICU delirium?What have been the major recent advances in delirium research and care?What are the common delirium beliefs that have been challenged by recent trials?What are the remaining areas of uncertainty in delirium research?What are some of the top study areas/trials to be done in the next 10 years? Herein, we briefly review the epidemiology of delirium, the current best practices for management of critically ill patients at risk for delirium or experiencing delirium; identify recent advances in our understanding of delirium as well as gaps in knowledge, and discuss research opportunities and barriers to implementation, with the goal of promoting an integrated research agenda.

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Validation and comparison of CAM-ICU and ICDSC in mild and moderate traumatic brain injury patients

Cited by 35 publications

References 5 publications

Early impairment of intracranial conduction time predicts mortality in deeply sedated critically ill patients: a prospective observational pilot study

Early impairment of intracranial conduction time predicts mortality in deeply sedated critically ill patients: a prospective observational pilot study

Delirium Screening in Neurocritical Care and Stroke Unit Patients: A Pilot Study on the Influence of Neurological Deficits on CAM-ICU and ICDSC Outcome

The intensive care delirium research agenda: a multinational, interprofessional perspective

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