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Advantages of score-based delirium detection compared to a clinical delirium assessment-a retrospective, monocentric
Markus Jäckel1,2, Nico Aicher1,2, Xavier Bemtgen1,2
1Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany.
Insights
Intensive care unit (ICU) physicians underdiagnose delirium. A Nudesc score-based delirium assessment identified more patients and predicted ICU mortality, unlike physician diagnosis.
Area of Science:
- Critical Care Medicine
- Neurology
- Geriatrics
Background:
- Delirium is frequently underdiagnosed in intensive care units (ICUs).
- Accurate delirium detection is crucial for patient outcomes.
- Current diagnostic methods by physicians may miss significant cases.
Purpose of the Study:
- To compare the effectiveness of a score-based delirium detection tool (Nudesc) against traditional physician diagnosis.
- To determine if Nudesc score-based detection identifies more delirium cases in the ICU.
- To evaluate the association of each diagnostic method with ICU length of stay and mortality.
Main Methods:
- Retrospective analysis of 943 patients admitted to a general medical ICU in 2019.
- Primary outcome: documented physician diagnosis of delirium versus a Nudesc score of 2 or higher.
- Statistical analysis to compare detection rates and predict ICU stay and mortality.
Main Results:
- Delirium was diagnosed in 21.7% of patients by physicians versus 46.4% using the Nudesc score (ratio 2.1).
- Both methods predicted ICU stay, but only Nudesc score predicted mortality (OR 2.31).
- Physicians underdiagnosed delirium in hypoactive cases, females, and patients under 60.
Conclusions:
- The Nudesc score significantly improves delirium detection in ICUs compared to physician diagnosis.
- Score-based delirium assessment is a better predictor of ICU mortality and length of stay.
- Targeted screening is needed for hypoactive delirium, female patients, and younger adults.
Purpose:
Delirium is an underdiagnosed complication on intensive care units (ICU). We hypothesized that a score-based delirium detection using the Nudesc score identifies more patients compared to a traditional diagnosis of delirium by ICU physicians.
Methods:
In this retrospective study, all patients treated on a general medical ICU with 30 beds in a university hospital in 2019 were analyzed. Primary outcome was a documented physician diagnosis of delirium, or a delirium score ≥2 using the Nudesc.
Results:
In 205/943 included patients (21.7%), delirium was diagnosed by ICU physicians compared to 438/943 (46.4%; ratio 2.1) by Nudesc≥2. Both assessments were independent predictors of ICU stay (p<0.01). The physician diagnosis however was no independent predictor of mortality (OR 0.98 (0.57-1.72); p = 0.989), in contrast to the score-based diagnosis (OR 2.31 (1.30-4.10); p = 0.004). Subgroup analysis showed that physicians underdiagnosed delirium in case of hypoactive delirium and delirium in patients with female gender and in patients with an age below 60 years.
Conclusion:
Delirium in patients with hypoactive delirium, female patients and those below 60 years was underdiagnosed by physicians. The score-based delirium diagnosis detected delirium more frequently and correlated with ICU mortality and stay.
