Publication type: Article in scientific journal
Type of review: Peer review (publication)
Title: Screening for delirium with the Intensive Care Delirium Screening Checklist (ICDSC) : symptom profile and utility of individual items in the identification of delirium dependent on the level of sedation
Authors: Boettger, Soenke
Meyer, Rafael
Richter, André
Fernandez, Susana Franco
Rudiger, Alain
Schubert, Maria
Jenewein, Josef
Nuñez, David Garcia
DOI: 10.1017/S1478951518000202
Published in: Palliative & Supportive Care
Issue Date: 24-May-2018
Publisher / Ed. Institution: Cambridge University Press
ISSN: 1478-9515
Language: English
Subjects: Text revision (DSM-IV-TR); Delirium; Diagnostic and Statistical Manual; Intensive Care Delirium Screening Checklist (ICDSC); Richmond Agitation and Sedation Scale (RASS); Intensive care unit (ICU); Phenomenology
Subject (DDC): 610.73: Nursing
616: Internal medicine and diseases
Abstract: Objective: The importance of the proper identification of delirium, with its high incidence and adversities in the intensive care setting, has been widely recognized. One common screening instrument is the Intensive Care Delirium Screening Checklist (ICDSC); however, the symptom profile and key features of delirium dependent on the level of sedation have not yet been evaluated. Method: In this prospective cohort study, the ICDSC was evaluated versus the Diagnostic and Statistical Manual, 4th edition, text revision, diagnosis of delirium set as standard with respect to the symptom profile, and correct identification of delirium. The aim of this study was to identify key features of delirium in the intensive care setting dependent on the Richmond Agitation and Sedation Scale levels of sedation: drowsiness versus alert and calmness. Result: The 88 delirious patients of 225 were older, had more severe disease, and prolonged hospitalization. Irrespective of the level of sedation, delirium was correctly classified by items related to inattention, disorientation, psychomotor alterations, inappropriate speech or mood, and symptom fluctuation. In the drowsy patients, inattention reached substantial sensitivity and specificity, whereas psychomotor alterations and sleep-wake cycle disturbances were sensitive lacked specificity. The positive prediction was substantial across items, whereas the negative prediction was only moderate. In the alert and calm patient, the sensitivities were substantial for psychomotor alterations, sleep-wake cycle disturbances, and symptom fluctuations; however, these fluctuations were not specific. The positive prediction was moderate and the negative prediction substantial. Between the nondelirious drowsy and alert, the symptom profile was similar; however, drowsiness was associated with alterations in consciousness. Significance of results: In the clinical routine, irrespective of the level of sedation, delirium was characterized by the ICDSC items for inattention, disorientation, psychomotor alterations, inappropriate speech or mood and symptom fluctuation. Further, drowsiness caused altered levels of consciousness.
Further description: 4th edition
Fulltext version: Published version
License (according to publishing contract): Licence according to publishing contract
Departement: School of Health Sciences
Organisational Unit: Institute of Nursing (IPF)
Appears in collections:Publikationen Gesundheit

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