Delirium assessment in neuro-critically ill patients: A validation study

Area of Science:

• Critical Care Medicine
• Neuroscience
• Psychiatry

Background:

• Delirium is under-investigated in neuro-critically ill patients, despite its known adverse effects in other ICU settings.
• Valid tools are needed for delirium detection in acute brain injury populations.
• This study aimed to assess delirium screening feasibility and validate tools in the Neuro-ICU.

Purpose of the Study:

• To validate and compare the Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for delirium detection.
• To assess the feasibility of delirium screening in adult patients with acute brain injury.
• To compare screening tool performance against the International Classification of Diseases-10 (ICD-10) criteria.

Main Methods:

• Adult patients in the Neuro-ICU with acute brain injury and a Richmond Agitation-Sedation Scale score of -2 or above were assessed.
• Delirium screening was performed using the CAM-ICU and ICDSC by nurses.
• Clinical assessment using ICD-10 criteria by psychiatrists served as the reference standard.

Main Results:

• Of 74 enrolled patients, 49 were included in the final analysis after 34% were deemed not assessable.
• The ICDSC demonstrated higher sensitivity (85%) and specificity (75%) compared to the CAM-ICU (59% sensitivity, 56% specificity).
• Feasibility of delirium screening in this population was challenged.

Conclusions:

• The Intensive Care Delirium Screening Checklist appears to be a valid tool for delirium detection in the Neuro-ICU.
• The Confusion Assessment Method for the ICU is less suitable for delirium assessment in neuro-critically ill patients.
• Delirium screening in neuro-critical care presents significant feasibility challenges.