Implications of Objective vs Subjective Delirium Assessment in Surgical Intensive Care Patients.

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State: Public
Version: author
Serval ID
serval:BIB_32F024D33547
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Implications of Objective vs Subjective Delirium Assessment in Surgical Intensive Care Patients.
Journal
American Journal of Critical Care : An Official Publication, American Association of Critical-care Nurses
Author(s)
Guenther U., Weykam J., Andorfer U., Theuerkauf N., Popp J., Ely E.W., Putensen C.
ISSN
1937-710X (Electronic)
ISSN-L
1062-3264
Publication state
Published
Issued date
2012
Peer-reviewed
Oui
Volume
21
Number
1
Pages
e12-e20
Language
english
Notes
Publication types: JOURNAL ARTICLEPublication Status: ppublish
Abstract
Background Delirium is an independent predictor of increased length of stay, mortality, and treatment costs in critical care patients. Its incidence may be underestimated or overestimated if delirium is assessed by using subjective clinical impression alone rather than an objective instrument. Objectives To determine frequency of discrepancies between subjective and objective delirium monitoring. Methods An observational cohort study was performed in a surgical-cardiosurgical 31-bed intensive care unit of a university hospital. Patients' delirium status was rated daily by bedside nurses on the basis of subjective individual clinical impressions and by medical students on the basis of scores on the objective Confusion Assessment Method for the Intensive Care Unit. Results Of 160 patients suitable for analysis, 38.8% (n = 62) had delirium according to objective criteria at some time during their stay in the intensive care unit. A total of 436 paired observations were analyzed. Delirium was diagnosed in 26.1% of observations (n = 114) with the objective method. This percentage included 6.4% (n = 28) in whom delirium was not recognized via subjective criteria. According to subjective criteria, delirium was present in 29.4% of paired observations (n = 128), including 9.6% (n = 42) with no objective indications of delirium. A total of 8 patients with no evidence of delirium according to the objective criteria were prescribed haloperidol and lorazepam because the subjective method indicated they had delirium. Conclusions Use of objective criteria helped detect delirium in more patients and also identified patients mistakenly thought to have delirium who actually did not meet objective criteria for diagnosis of the condition.
Pubmed
Web of science
Open Access
Yes
Create date
20/01/2012 12:29
Last modification date
20/08/2019 14:18
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