CAM-ICU and ICDSC agreement in medical and surgical ICU patients is influenced by disease severity.

<h4>Introduction</h4>Delirium is a prevalent condition in patients admitted to intensive care units (ICU) associated with worse outcomes. The principal aim of the present study was compare the agreement between two tools for delirium assessment in medical and surgical patients admitted t...

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Autores principales: Jorge Alberto de Oliveira Fagundes, Cristiane Damiani Tomasi, Vinicius Rene Giombelli, Sarah Cascaes Alves, Roberta Candal de Macedo, Maria Fernanda Locks Topanotti, Maria de Lourdes Ugioni Bristot, Pedro Emmanuel Alvarenga Americano do Brasil, Márcio Soares, Jorge Salluh, Felipe Dal-Pizzol, Cristiane Ritter
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Publicado: Public Library of Science (PLoS) 2012
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spelling oai:doaj.org-article:ebb9c644c39a4b5998287833362050f42021-11-18T08:06:36ZCAM-ICU and ICDSC agreement in medical and surgical ICU patients is influenced by disease severity.1932-620310.1371/journal.pone.0051010https://doaj.org/article/ebb9c644c39a4b5998287833362050f42012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23226448/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>Delirium is a prevalent condition in patients admitted to intensive care units (ICU) associated with worse outcomes. The principal aim of the present study was compare the agreement between two tools for delirium assessment in medical and surgical patients admitted to the ICU.<h4>Methods</h4>Consecutive adult surgical and medical patients admitted to the ICU for more than 24 hours between March 2009 and September 2010 were included. Delirium was evaluated twice a day using the Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment Method adapted to the Intensive Care Unit (CAM-ICU). The kappa (k) and AC1 coefficients were calculated as a measure of agreement between the CAM-ICU and ICDSC.<h4>Results</h4>A total of 595 patients were enrolled in the study. There were 69 (12%) emergency surgical, 207 (35%) elective surgical and 319 (54%) medical patients. Delirium incidence evaluated by the ICDSC, but not by the CAM-ICU, was similar among the three groups. Overall agreement between CAM-ICU and ICDSC was moderate (k = 0.5) to substantial (AC1 = 0.71). In medical patients the agreement between the two instruments was moderate (k = 0.53) to substantial (AC1 = 0.76). The agreement between the two tools in emergency surgical patients was also moderate (k = 0.53) to substantial (AC1 = 0.68). In elective surgical patients the agreement between the two instruments was low (k = 0.42) to substantial (AC1 = 0.74).Agreement rates seemed to be influenced by disease severity. The agreement rate in the general ICU population with APACHE II = <14 was k = 0.57 and AC1 = 0.81, compared to k = 0.44 and AC1 = 0.59, in patients with more severe disease. This was even more different when the need for mechanical ventilation was used as a surrogate of disease severity.<h4>Conclusions</h4>The agreement rates between CAM-ICU and ICDSC may vary between different groups of ICU patients and seems to be affected by disease severity.Jorge Alberto de Oliveira FagundesCristiane Damiani TomasiVinicius Rene GiombelliSarah Cascaes AlvesRoberta Candal de MacedoMaria Fernanda Locks TopanottiMaria de Lourdes Ugioni BristotPedro Emmanuel Alvarenga Americano do BrasilMárcio SoaresJorge SalluhFelipe Dal-PizzolCristiane RitterPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 11, p e51010 (2012)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Jorge Alberto de Oliveira Fagundes
Cristiane Damiani Tomasi
Vinicius Rene Giombelli
Sarah Cascaes Alves
Roberta Candal de Macedo
Maria Fernanda Locks Topanotti
Maria de Lourdes Ugioni Bristot
Pedro Emmanuel Alvarenga Americano do Brasil
Márcio Soares
Jorge Salluh
Felipe Dal-Pizzol
Cristiane Ritter
CAM-ICU and ICDSC agreement in medical and surgical ICU patients is influenced by disease severity.
description <h4>Introduction</h4>Delirium is a prevalent condition in patients admitted to intensive care units (ICU) associated with worse outcomes. The principal aim of the present study was compare the agreement between two tools for delirium assessment in medical and surgical patients admitted to the ICU.<h4>Methods</h4>Consecutive adult surgical and medical patients admitted to the ICU for more than 24 hours between March 2009 and September 2010 were included. Delirium was evaluated twice a day using the Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment Method adapted to the Intensive Care Unit (CAM-ICU). The kappa (k) and AC1 coefficients were calculated as a measure of agreement between the CAM-ICU and ICDSC.<h4>Results</h4>A total of 595 patients were enrolled in the study. There were 69 (12%) emergency surgical, 207 (35%) elective surgical and 319 (54%) medical patients. Delirium incidence evaluated by the ICDSC, but not by the CAM-ICU, was similar among the three groups. Overall agreement between CAM-ICU and ICDSC was moderate (k = 0.5) to substantial (AC1 = 0.71). In medical patients the agreement between the two instruments was moderate (k = 0.53) to substantial (AC1 = 0.76). The agreement between the two tools in emergency surgical patients was also moderate (k = 0.53) to substantial (AC1 = 0.68). In elective surgical patients the agreement between the two instruments was low (k = 0.42) to substantial (AC1 = 0.74).Agreement rates seemed to be influenced by disease severity. The agreement rate in the general ICU population with APACHE II = <14 was k = 0.57 and AC1 = 0.81, compared to k = 0.44 and AC1 = 0.59, in patients with more severe disease. This was even more different when the need for mechanical ventilation was used as a surrogate of disease severity.<h4>Conclusions</h4>The agreement rates between CAM-ICU and ICDSC may vary between different groups of ICU patients and seems to be affected by disease severity.
format article
author Jorge Alberto de Oliveira Fagundes
Cristiane Damiani Tomasi
Vinicius Rene Giombelli
Sarah Cascaes Alves
Roberta Candal de Macedo
Maria Fernanda Locks Topanotti
Maria de Lourdes Ugioni Bristot
Pedro Emmanuel Alvarenga Americano do Brasil
Márcio Soares
Jorge Salluh
Felipe Dal-Pizzol
Cristiane Ritter
author_facet Jorge Alberto de Oliveira Fagundes
Cristiane Damiani Tomasi
Vinicius Rene Giombelli
Sarah Cascaes Alves
Roberta Candal de Macedo
Maria Fernanda Locks Topanotti
Maria de Lourdes Ugioni Bristot
Pedro Emmanuel Alvarenga Americano do Brasil
Márcio Soares
Jorge Salluh
Felipe Dal-Pizzol
Cristiane Ritter
author_sort Jorge Alberto de Oliveira Fagundes
title CAM-ICU and ICDSC agreement in medical and surgical ICU patients is influenced by disease severity.
title_short CAM-ICU and ICDSC agreement in medical and surgical ICU patients is influenced by disease severity.
title_full CAM-ICU and ICDSC agreement in medical and surgical ICU patients is influenced by disease severity.
title_fullStr CAM-ICU and ICDSC agreement in medical and surgical ICU patients is influenced by disease severity.
title_full_unstemmed CAM-ICU and ICDSC agreement in medical and surgical ICU patients is influenced by disease severity.
title_sort cam-icu and icdsc agreement in medical and surgical icu patients is influenced by disease severity.
publisher Public Library of Science (PLoS)
publishDate 2012
url https://doaj.org/article/ebb9c644c39a4b5998287833362050f4
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