Predicting hospital mortality and length of stay: A prospective cohort study comparing the Intensive Care Delirium Screening Checklist versus Confusion Assessment Method for the Intensive Care Unit. Issue 3 (May 2023)

• Record Type: Journal Article
• Authors: Li, Hsiu-Ching; Chen, Cheryl Chia-Hui; Yeh, Tony Yu-Chang; Liao, Shih-Cheng; Hsu, Adrian-Shengchun; Wei, Yu-Chung; Shun, Shiow-Ching; Ku, Shih-Chi; Inouye, Sharon K.
• Is Part Of: Australian critical care. Volume 36:Issue 3(2023)
• Page Start: 378
• Page End: 384
• Publication Date: 2023-05
• Subjects: ICDSC (Intensive Care Delirium Screening Checklist) -- CAM-ICU (Confusion Assessment Method for Intensive Care Unit) -- Mortality -- Delirium -- Consciousness -- RASS (Richmond Agitation–Sedation Scale); Intensive care nursing -- Periodicals; Intensive care nursing -- Australia -- Periodicals; Electronic journals; 616.028
• DOI: 10.1016/j.aucc.2022.01.010
• Languages: English
• ISSNs: 1036-7314

Abstract

Abstract: Objective: The objective of this study was to compare two tools, the Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment Method for the intensive care unit (ICU) (CAM-ICU), for their predictive validity for outcomes related to delirium, hospital mortality, and length of stay (LOS). Methods: The prospective study conducted in six medical ICUs at a tertiary care hospital in Taiwan enrolled consecutive patients (≥20 years) without delirium at ICU admission. Delirium was screened daily using the ICDSC and CAM-ICU in random order. Arousal was assessed by the Richmond Agitation–Sedation Scale (RASS). Participants with any one positive result were classified as ICDSC- or CAM-ICU-delirium groups. Results: Delirium incidence evaluated by the ICDSC and CAM-ICU were 69.1% (67/97) and 50.5% (49/97), respectively. Although the ICDSC identified 18 more cases as delirious, substantial concordance (κ = 0.63; p < 0.001) was found between tools. Independent of age, Acute Physiology and Chronic Health Evaluation II score, and Charlson Comorbidity Index, both ICDSC- and CAM-ICU-rated delirium significantly predicted hospital mortality (adjusted odds ratio: 4.93; 95% confidence interval [CI]:1.56 to 15.63 vs . 2.79; 95% CI: 1.12 to 6.97, respectively), and only the ICDSC significantly predicted hospital LOS with a mean of 17.59 additional days compared with the no-delirium group. Irrespective of delirium status, a sensitivity analysis of normal-to-increased arousal (RASS≥0) test results did not alter the predictive ability of ICDSC- or CAM-ICU-delirium for hospital mortality (adjusted odds ratio: 2.97; 95% CI: 1.06 to 8.37 vs . 3.82; 95% CI: 1.35 to 10.82, respectively). With reduced arousal (RASS<0), neither tool significantly predicted mortality or LOS. Conclusions: The ICDSC identified more delirium cases and may have higher predictive validity for mortality and LOS than the CAM-ICU. However, arousal substantially affected performance. Future studies may want to consider patients' arousal when deciding which tool to use to maximise the effects of delirium identification on patient mortality.