Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals

BACKGROUNDDelirium is highly prevalent in critically ill patients. Its detection with valid tools is crucial.OBJECTIVETo analyze the development and psychometric properties of delirium assessment tools for critically ill adults.METHODSDatabases were searched to identify relevant studies. Inclusion criteria were English language, publication before January 2015, 30 or more patients, and patient population of critically ill adults (>18 years old). Search terms were delirium, scales, critically ill patients, adult, validity, and reliability. Thirty-six manuscripts were identified, encompassing 5 delirium assessment tools (Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), Cognitive Test for Delirium, Delirium Detection Score, Intensive Care Delirium Screening Checklist (ICDSC), and Nursing Delirium Screening Scale). Two independent reviewers analyzed the psychometric properties of these tools by using a standardized scoring system (range, 0–20) to assess the tool development process, reliability, validity, feasibility, and implementation of each tool.RESULTSPsychometric properties were very good for the CAM-ICU (19.6) and the ICDSC (19.2), moderate for the Nursing Delirium Screening Scale (13.6), low for the Delirium Detection Score (11.2), and very low for the Cognitive Test for Delirium (8.2).CONCLUSIONSThe results indicate that the CAM-ICU and the ICDSC are the most valid and reliable delirium assessment tools for critically ill adults. Additional studies are needed to further validate these tools in critically ill patients with neurological disorders and those at various levels of sedation or consciousness.

Download Full-text

Hospital and nursing home patients’ experiences with delirium assessments: A qualitative content analysis

Nordic Journal of Nursing Research ◽

10.1177/2057158519882823 ◽

2019 ◽

Vol 40 (1) ◽

pp. 52-58

Author(s):

Helle Svenningsen ◽

Dorthe Sørensen

Keyword(s):

Content Analysis ◽

Nursing Home ◽

Qualitative Method ◽

Healthcare Professionals ◽

Qualitative Content Analysis ◽

Well Being ◽

Relevant Information ◽

Delirium Assessment ◽

Face To Face ◽

Nursing Home Patients

To explore hospital and nursing home patients’ experiences with delirium assessments and better understand their attitudes, we used a qualitative method to summarise, in everyday terms, specific events observed by researchers and experienced by patients. We performed participant observations of delirium assessments of eight patients and conducted individual semi-structured face-to-face interviews with seven other patients. We carried out content analysis using an inductive approach. Our findings indicate that patients approached delirium assessment with initial scepticism due to a lack of knowledge. Their scepticism changed to complete acceptance after the assessment’s purpose was explained. However, some patients gave up on the assessment due to cognitive challenges, lack of energy, fatigue, or language barriers. Patients appreciated that professionals were interested in their mental and physical well-being. Despite initial scepticism, the patients found the delirium assessment valuable when they better understood its purpose. Thus, healthcare professionals should provide patients with relevant information about delirium assessments.

Download Full-text