Delirium assessment in neuro-critically ill patients: A validation study

Background:Delirium is underinvestigated in the neuro‐critically ill, although theharmful effect of delirium is well established in patients in medical and surgicalintensive care units (ICU).To detect delirium, a valid tool is needed. We hypothe-sized that delirium screening would be feasible in patients with acute brain injuryand we aimed to validate and compare the Confusion Assessment Method for theICU and the Intensive Care Delirium Screening Checklist against clinical InternationalClassification of Diseases‐10 criteria as reference.

Methods:Nurses assessed delirium using the Confusion Assessment Method forthe ICU and Intensive Care Delirium Screening Checklist in adult patients with acutebrain injury admitted to the Neurointensive care unit (Neuro‐ICU), CopenhagenUniversity Hospital, if their Richmond agitation‐sedation scale score was−2orabove. As the reference, a team of psychiatrist assessed patients using the Interna-tional Classification of Diseases‐10 criteria.

Results:We enrolled 74 patients, of whom 25 (34%) were deemed unable to assessby the psychiatrists, leaving 49 (66%) for final analysis. Sensitivity and specificity forthe Confusion Assessment Method for the ICU was 59% (95% CI: 41‐75) and 56%(95% CI: 32‐78), respectively, and 85% (95% CI: 70‐94) and 75% (95% CI: 51‐92),respectively, for the Intensive Care Delirium Screening Checklist.

Conclusions:Our findings suggest that the Intensive Care Delirium ScreeningChecklist may be a valid tool and the Confusion Assessment Method for the ICU isless suitable for delirium detection for patients in the Neuro‐ICU. In the neuro‐criti-cally ill, delirium screening is challenged by limited feasibility.