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Screening for delirium with the Intensive Care Delirium Screening Checklist (ICDSC): Symptom profile and utility of individual items in the identification of delirium dependent on the level of sedation

Published online by Cambridge University Press:  24 May 2018

Soenke Boettger ,
Rafael Meyer ,
André Richter ,
Susana Franco Fernandez ,
Alain Rudiger ,
Maria Schubert ,
Josef Jenewein  and
David Garcia Nuñez
Soenke Boettger*
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University Zurich, Zurich, Switzerland
Rafael Meyer
Affiliation:
Pychiatric Services Aargau AG, Departement Geronto- and NeuropsychiatryDättwil, Switzerland
André Richter
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University Zurich, Zurich, Switzerland
Susana Franco Fernandez
Affiliation:
Institute of Anaesthesiology, University Hospital Zurich, University Zurich, Zurich, Switzerland
Alain Rudiger
Affiliation:
Institute of Anaesthesiology, University Hospital Zurich, University Zurich, Zurich, Switzerland
Maria Schubert
Affiliation:
Inselspital, University Hospital Bern, Directorate of Nursing/MTT, Bern, Switzerland
Josef Jenewein
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University Zurich, Zurich, Switzerland
David Garcia Nuñez
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University Zurich, Zurich, Switzerland University Basel, University Hospital Basel, Basel, Switzerland
*
Author for correspondence: Soenke Boettger, Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University Zurich, Ramistrasse 100, 8091 Zurich, Switzerland. E-mail: soenke.boettger@usz.ch
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Abstract

Objective

The importance of the proper identification of delirium, with its high incidence and adversities in the intensive care setting, has been widely recognized. One common screening instrument is the Intensive Care Delirium Screening Checklist (ICDSC); however, the symptom profile and key features of delirium dependent on the level of sedation have not yet been evaluated.

Method

In this prospective cohort study, the ICDSC was evaluated versus the Diagnostic and Statistical Manual, 4th edition, text revision, diagnosis of delirium set as standard with respect to the symptom profile, and correct identification of delirium. The aim of this study was to identify key features of delirium in the intensive care setting dependent on the Richmond Agitation and Sedation Scale levels of sedation: drowsiness versus alert and calmness.

Result

The 88 delirious patients of 225 were older, had more severe disease, and prolonged hospitalization. Irrespective of the level of sedation, delirium was correctly classified by items related to inattention, disorientation, psychomotor alterations, inappropriate speech or mood, and symptom fluctuation. In the drowsy patients, inattention reached substantial sensitivity and specificity, whereas psychomotor alterations and sleep-wake cycle disturbances were sensitive lacked specificity. The positive prediction was substantial across items, whereas the negative prediction was only moderate. In the alert and calm patient, the sensitivities were substantial for psychomotor alterations, sleep-wake cycle disturbances, and symptom fluctuations; however, these fluctuations were not specific. The positive prediction was moderate and the negative prediction substantial. Between the nondelirious drowsy and alert, the symptom profile was similar; however, drowsiness was associated with alterations in consciousness.

Significance of results

In the clinical routine, irrespective of the level of sedation, delirium was characterized by the ICDSC items for inattention, disorientation, psychomotor alterations, inappropriate speech or mood and symptom fluctuation. Further, drowsiness caused altered levels of consciousness.

Keywords

Deliriumintensive care unit (ICU)phenomenologyIntensive Care Delirium Screening Checklist (ICDSC)Diagnostic and Statistical Manual, 4th edition, text revision (DSM-IV-TR)Richmond Agitation and Sedation Scale (RASS)
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 1 , February 2019 , pp. 74 - 81
Copyright
Copyright © Cambridge University Press 2018 

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