Patient Factors That Influence Reliable Delirium Assessments in a Medical Intensive Care Unit During the Routine...

Area of Science:

• Critical Care Medicine
• Neuroscience
• Geriatrics

Background:

• Delirium is a common complication in the medical intensive care unit (MICU).
• Accurate delirium assessment is crucial for patient management and outcomes.
• Routine clinical practice may yield inconsistent delirium assessment results.

Purpose of the Study:

• To identify patient and therapeutic characteristics associated with inconsistent delirium assessments in the MICU.
• To analyze factors contributing to discrepancies in Confusion Assessment Method in the ICU (CAM-ICU) results.
• To improve the reliability of delirium detection in critically ill patients.

Main Methods:

• Retrospective review of electronic health records from MICU patients.
• Comparison of routine clinical assessments with secondary CAM-ICU data.
• Statistical analysis to identify factors correlating with assessment disagreements.

Main Results:

• 15.78% of 5,241 cases (762 patients) showed disagreement between delirium assessments.
• Continuous renal replacement therapy, physical restraint use, and altered mental status were linked to increased assessment inconsistencies.
• A positive correlation was observed between CAM-ICU disagreement rates and the monthly assessment volume.

Conclusions:

• Patient-specific factors and treatment modalities significantly impact delirium assessment reliability.
• A higher frequency of assessments correlates with increased disagreement rates.
• Individualized assessment strategies, considering consciousness and treatment, are essential for reliable delirium detection.