Measuring clinical confusion in critically ill patients

Area of Science:

• Critical Care Medicine
• Nursing Research
• Psychometrics

Background:

• Confusion in critically ill patients is often undetected by nurses during routine interviews.
• Undetected confusion poses risks, including self-injury and prolonged recovery for critically ill patients.
• There is a need for reliable and valid methods to identify patients at risk of developing confusion.

Purpose of the Study:

• To evaluate the reliability and validity of three confusion assessment tools in a medical intensive care unit (MICU).
• To determine if these instruments can accurately identify confusion in critically ill patients.

Main Methods:

• The study involved 53 critically ill patients in a MICU over 3-8 days, collecting 140 sets of data.
• Three instruments were administered: Mini-mental State Examination (MMSE), Clinical Assessment of Confusion-A (CAC-A), and Visual Analog Scale of Confusion (VAS-C).
• Psychometric analyses were conducted to assess reliability and validity.

Main Results:

• Psychometric analyses confirmed that the MMSE, CAC-A, and VAS-C are reliable and valid instruments for assessing confusion in critically ill patients.
• High correlations were observed between the three assessment tools.
• Agreement in test scores and clinical confusion assessment was noted on over 75% of study days.

Conclusions:

• The MMSE, CAC-A, and VAS-C are effective and reliable tools for identifying confusion in critically ill patients within a MICU setting.
• These validated instruments can aid nurses in the early detection of confusion, potentially improving patient outcomes.
• Implementing these tools can enhance the safety and care of critically ill patients by addressing undetected confusion.