Video Monitoring for Agitated Delirium in Palliative Care: Secondary Analysis of the RECORD Trial

Video recording facilitates continuous monitoring of patients with agitated delirium, but its role in inpatient palliative care remains unexplored.

This study examined the benefit of video monitoring for assessing persistent agitated delirium in an inpatient palliative supportive care unit (PSCU).

This was a prospective observational study as a part of secondary analysis of a multicenter, double-blind, randomized clinical trial examining the proportional sedation for palliative supportive care unit (PSCU) patients with persistent agitated delirium (RECORD trial). The presence or absence of agitation (modified Richmond Agitation-Sedation Scale [RASS] score, ≥+1 vs. ≤0) was documented over 24 hour using various methods (in-person vs. video), observer occupations (registered nurse [RN] vs. physician [MD]), and frequencies (intermittent [every two hours] vs. continuous [every five minute]).

Fourteen patients underwent 227.2 hours of video monitoring (median: 16.2 hour/patient; IQR, 12.4-22.2 hours), including 170 in-person intermittent RN, 109 video intermittent RN, 109 video intermittent MD, and 2445 video continuous MD RASS assessments. Agreement (generalized estimating equations) was 75% between in-person and video intermittent RN RASS assessments, 95% between video intermittent RN and MD RASS assessments, and 73% between video intermittent and continuous MD RASS assessments. Video intermittent RN RASS assessment documented 17 (16%) agitation episodes, whereas in-person RN RASS assessment did not. Also, in-person RN RASS assessment documented 10 (9%) agitation episodes, whereas video intermittent RN RASS assessment did not. Video continuous MD RASS assessment identified 28% more agitation episodes than video intermittent MD RASS assessment and revealed three patterns of agitation (persistent, interval, and intermittent).

Our preliminary findings highlight the level of interrater agreement of video monitoring with in-person assessments and its potential advantage to provide higher resolution data and patterns of agitation.