CAM-ICU and ICDSC agreement in medical and surgical ICU patients is influenced by disease severity

• Published in: PloS one 2012-11, Vol.7 (11), p.e51010-e51010
• Main Authors: Fagundes, Jorge Alberto de Oliveira, Tomasi, Cristiane Damiani, Giombelli, Vinicius Rene, Alves, Sarah Cascaes, de Macedo, Roberta Candal, Topanotti, Maria Fernanda Locks, de Lourdes Ugioni Bristot, Maria, do Brasil, Pedro Emmanuel Alvarenga Americano, Soares, Márcio, Salluh, Jorge, Dal-Pizzol, Felipe, Ritter, Cristiane
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia; Checklist; Computer aided manufacturing; Critical care; Delirium; Delirium - diagnosis; Emergency medical services; Female; Hospital patients; Hospitalization; Hospitals; Humans; Intensive care; Intensive Care Units; Male; Mechanical ventilation; Medical diagnosis; Medical research; Medicine; Mental disorders; Middle Aged; Patients; Respiration, Artificial; Severity of Illness Index; Surgery; Surgical instruments; Surgical Procedures, Operative; Ventilation
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0051010

Delirium is a prevalent condition in patients admitted to intensive care units (ICU) associated with worse outcomes. The principal aim of the present study was compare the agreement between two tools for delirium assessment in medical and surgical patients admitted to the ICU. Consecutive adult surgical and medical patients admitted to the ICU for more than 24 hours between March 2009 and September 2010 were included. Delirium was evaluated twice a day using the Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment Method adapted to the Intensive Care Unit (CAM-ICU). The kappa (k) and AC1 coefficients were calculated as a measure of agreement between the CAM-ICU and ICDSC. A total of 595 patients were enrolled in the study. There were 69 (12%) emergency surgical, 207 (35%) elective surgical and 319 (54%) medical patients. Delirium incidence evaluated by the ICDSC, but not by the CAM-ICU, was similar among the three groups. Overall agreement between CAM-ICU and ICDSC was moderate (k = 0.5) to substantial (AC1 = 0.71). In medical patients the agreement between the two instruments was moderate (k = 0.53) to substantial (AC1 = 0.76). The agreement between the two tools in emergency surgical patients was also moderate (k = 0.53) to substantial (AC1 = 0.68). In elective surgical patients the agreement between the two instruments was low (k = 0.42) to substantial (AC1 = 0.74).Agreement rates seemed to be influenced by disease severity. The agreement rate in the general ICU population with APACHE II =