Validation of the Intensive Care Delirium Screening Checklist in nonintubated intensive care unit patients in a resource-poor medical intensive care setting in South India

George, Christina; Nair, Jayakrishnan Sukumaran; Ebenezer, Johann Alex; Gangadharan, Alan; ChristuDas, Anna; Libu, Gnanaseelan Kanakamma; Jacob, K. S.

doi:10.1016/j.jcrc.2010.11.002

Cited by 46 publications

(38 citation statements)

References 12 publications

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“…Two studies suggest an improved accuracy with different cutoffs [9,21]. George et al showed an optimal threshold for screening with a score of 3 [21].…”

Section: Resultsmentioning

confidence: 99%

“…George et al showed an optimal threshold for screening with a score of 3 [21]. Compared with a cutoff of 4, the sensitivity increased from 75% to 90%; however, the specificity decreased from 74.3% to 61.5%.…”

Section: Resultsmentioning

confidence: 99%

“…These results suggest that this tool does not appear to be as accurate as the CAM-ICU for screening purposes. George et al , using a different threshold for positivity (3 rather than 4), showed a higher sensitivity (from 75% to 90%) and, consequently, improved screening characteristics of this tool [21]. However, these changes in the cutoff decreased the specificity of the ICDSC, which was already lower than that observed for the CAM-ICU.…”

Section: Discussionmentioning

confidence: 99%

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The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies

et al. 2012

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IntroductionDelirium is a frequent form of acute brain dysfunction in critically ill patients, and several detection tools for it have been developed for use in the Intensive Care Unit (ICU). The objective of this study is to evaluate the current evidence on the accuracy of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for the diagnosis of delirium in critically ill patients.MethodsA systematic review was conducted to identify articles on the evaluation of the CAM-ICU and the ICDSC in ICU patients. A MEDLINE, SciELO, CINAHL and EMBASE databases search was performed for articles published in the English language, involving adult populations and comparing these diagnostic tools with the gold standard, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Results were summarized by meta-analysis. The QUADAS scale was used to assess the quality of the studies.ResultsNine studies evaluating the CAM-ICU (including 969 patients) and four evaluating the ICDSC (n = 361 patients) were included in the final analysis. The pooled sensitivity of the CAM-ICU was 80.0% (95% confidence interval (CI): 77.1 to 82.6%), and the pooled specificity was 95.9% (95% CI: 94.8 to 96.8%). The diagnostic odds ratio was 103.2 (95% CI: 39.6 to 268.8). The pooled area under the summary receiver operating characteristic curve (AUC) was 0.97. The pooled sensitivity of the ICDSC was 74% (95% CI: 65.3 to 81.5%), and the pooled specificity was 81.9% (95% CI: 76.7 to 86.4%). The diagnostic odds ratio was 21.5 (95% CI: 8.51 to 54.4). The AUC was 0.89.ConclusionsThe CAM-ICU is an excellent diagnostic tool in critically ill ICU patients, whereas the ICDSC has moderate sensitivity and good specificity. The available data suggest that both CAM-ICU and the ICDSC can be used as a screening tool for the diagnosis of delirium in critically ill patients.

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“…Two studies suggest an improved accuracy with different cutoffs [9,21]. George et al showed an optimal threshold for screening with a score of 3 [21].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies

et al. 2012

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“…(10) ICDSC, despite having been studied as a diagnostic tool, exhibits varied specificity. (10,29,30) Thus, the ICDSC can generate false-positive results. (25,27) However, meta-analyses and recent guidelines suggest that the CAM-ICU and ICDSC are the best-studied instruments for the diagnosis of delirium; therefore, they are suggested as the tools of choice for this purpose.…”

Section: Discussionmentioning

confidence: 99%

Delirium rating scales in critically ill patients: a systematic literature review

Carvalho

Almeida

Gusmao-Flores

2013

Revista Brasileira De Terapia Intensiva

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ObjectiveTo identify scales that can establish a quantitative assessment of delirium symptoms in critically ill patients through a systematic review. MethodsStudies that evaluated delirium stratification scales in patients hospitalized in intensive care units were selected in a search performed in the MedLine database. Validation studies of these scales and their target patient populations were analyzed, and we identified the examiner and the signs and symptoms evaluated. In addition, the duration of the application and the sensitivity and specificity of each scale were assessed. ResultsSix scales were identified: the Delirium Detection Score, the Cognitive Test of Delirium, the Memorial Delirium Assessment Scale, the Intensive Care Delirium Screening Checklist, The Neelon and Champagne Confusion Scale and the Delirium Rating Scale-Revised-98. ConclusionThe scales identified allow the stratification and monitoring of critically ill patients with delirium. Among the six scales, the most studied and best suited for use in the intensive care units was the Intensive Care Delirium Screening Checklist.

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“…Five studies (Table 3) have evaluated the ICDSC against DSM reference raters. (7, 46, 47, 52, 53) All studies enrolled in mixed ICUs and included 465 patients, both ventilated and non-ventilated.…”

Section: Delirium Screening Tools In the Adult Icumentioning

confidence: 99%

Implementing Delirium Screening in the ICU

Brummel

Vasilevskis

Han

et al. 2013

Critical Care Medicine

130

112

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Objective To review delirium screening tools available for use in the adult and pediatric ICU, review evidence-based delirium screening implementation and to discuss common pitfalls encountered during delirium screening in the ICU. Data Sources Review of delirium screening literature and expert opinion. Results Over the past decade, tools specifically designed for use in critically ill adults and children have been developed and validated. Delirium screening has been effectively implemented across many ICUs settings. Keys to effective implementation include addressing barriers to routine screening, multi-faceted training such as lectures, case-based scenarios, one-on-one teaching and real-time feedback of delirium screening and interdisciplinary communication through discussion of a patient’s delirium status during bedside rounds and through documentation systems. If delirium is present clinicians should search for reversible or treatable causes since it is often multifactorial. Conclusion Implementation of effective delirium screening is feasible but requires attention to implementation methods, including a change in the current ICU culture that believes delirium is inevitable or a normal part of a critical illness, to a future culture that views delirium as a dangerous syndrome which portends poor clinical outcomes and which is potentially modifiable depending on the individual patients circumstances.

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Validation of the Intensive Care Delirium Screening Checklist in nonintubated intensive care unit patients in a resource-poor medical intensive care setting in South India

Cited by 46 publications

References 12 publications

The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies

The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies

Delirium rating scales in critically ill patients: a systematic literature review

Implementing Delirium Screening in the ICU

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