Electroencephalography in Delirium Assessment. A Scoping Review

2021 ◽  
Author(s):  
Tim Wiegand ◽  
Jan Rémi ◽  
Konstantinos Dimitriadis
Keyword(s):  
Scoping Review ◽  
Quantitative Eeg ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Diagnostic Methods ◽  
Delirium Assessment ◽  
Assessment Scores ◽  
Clear Cut ◽  
Beta Power ◽  
Continuous Eeg

Abstract BackgroundDelirium is a common disorder affecting up to 82% of patients in the intensive care unit (ICU). Delirium assessment scores such as the Confusion Assessment Method (CAM) are time-consuming, they cannot differentiate between different types of delirium and their etiologies, and they may have low sensitivities in the clinical setting. While today, electroencephalography (EEG) is increasingly being applied to delirious patients in the ICU, a lack of clear cut EEG signs, leads to inconsistent assessments. MethodsWe therefore conducted a scoping review on EEG findings in delirium. 1236 articles identified through database search on PubMed and Embase were reviewed. Finally, 33 original articles were included in the synthesis. ResultsEEG seems to offer manifold possibilities in diagnosing delirium. All 33 studies showed a certain degree of qualitative or quantitative EEG alterations in delirium. Thus, normal routine (rEEG) and continuous EEG (cEEG) make presence of delirium very unlikely. All 33 studies used different research protocols to at least some extent. These include differences in time points, duration, conditions, and recording methods of EEG, as well as different patient populations, and diagnostic methods for delirium. Thus, a quantitative synthesis and common recommendations are so far elusive. ConclusionFuture studies should compare the different methods of EEG recording and evaluation to identify robust parameters for everyday use. Evidence for quantitative bi-electrode delirium detection based on increased relative delta power and decreased beta power is growing and should be further pursued. Additionally, EEG studies on the evolution of a delirium including patient outcomes are needed.

Delirium classification by the diagnostic and statistical manual – a moving target

2015 ◽  
Vol 27 (6) ◽  
pp. 881-882 ◽  
Author(s):  
Karin J. Neufeld
Keyword(s):  
Rating Scale ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Classification Systems ◽  
Diagnostic Systems ◽  
Delirium Assessment ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Medical Inpatients ◽  
Dsm Iv

The following paper, entitled “A Comparison of Delirium Diagnosis in Elderly Medical Inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 Criteria” by Adamis and colleagues, reports the results of a single delirium assessment of 200 medical inpatients, aged 70 years and older. The aim was to compare the prevalence of delirium using two different diagnostic classification systems (DSM-5 and DSM-IV) and two commonly used research tools (Confusion Assessment Method and the Delirium Rating Scale-Revised ‘98). This editorial focuses on the comparison of the two versions of the DSM. The authors conclude that, while both diagnostic systems identify a core concept of delirium, the DSM-IV criteria are the most inclusive of the four approaches and the DSM-5, the most restrictive, identifying a prevalence of 19.5% and 13%, respectively in this sample. Furthermore, they conclude that these two systems do not appear to detect the same patients: only 14 of 26 (54%) individuals identified as delirious by the more exclusive DSM-5 criteria were also identified as such by DSM-IV.

Assessment of Delirium in the Intensive Care Unit: Nursing Practices And Perceptions

2008 ◽  
Vol 17 (6) ◽  
pp. 555-565 ◽  
Author(s):  
John W. Devlin ◽  
Jeffrey J. Fong ◽  
Elizabeth P. Howard ◽  
Yoanna Skrobik ◽  
Nina McCoy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Delirium Assessment ◽  
Web Based ◽  
Altered Level ◽  
Invasive Device ◽  
Few Data

Background Despite practice guidelines promoting delirium assessment in intensive care, few data exist regarding current delirium assessment practices among nurses and how these practices compare with those for sedation assessment. Objectives To identify current practices and perceptions of intensive care nurses regarding delirium assessment and to compare practices for assessing delirium with practices for assessing sedation. Methods A paper/Web-based survey was administered to 601 staff nurses working in 16 intensive care units at 5 acute care hospitals with sedation guidelines specifying delirium assessment in the Boston, Massachusetts area. Results Overall, 331 nurses (55%) responded. Only 3% ranked delirium as the most important condition to evaluate, compared with altered level of consciousness (44%), presence of pain (23%), or improper placement of an invasive device (21%). Delirium assessment was less common than sedation assessment (47% vs 98%, P < .001) and was more common among nurses who worked in medical intensive care units (55% vs 40%, P = .03) and at academic centers (53% vs 13%, P < .001). Preferred methods for assessing delirium included assessing ability to follow commands (78%), checking for agitation-related events (71%), the Confusion Assessment Method for the Intensive Care Unit (36%), the Intensive Care Delirium Screening Checklist (11%), and psychiatric consultation (9%). Barriers to assessment included intubation (38%), complexity of the tool for assessing delirium (34%), and sedation level (13%). Conclusions Practice and perceptions of delirium assessment vary widely among critical care nurses despite the presence of institutional sedation guidelines that promote delirium assessment.

scholarly journals Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers

2019 ◽  
Vol 49 (1) ◽  
pp. 130-134
Author(s):  
Krishan Yadav ◽  
Valérie Boucher ◽  
Pierre-Hugues Carmichael ◽  
Philippe Voyer ◽  
Debra Eagles ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sensitivity And Specificity ◽  
Primary Outcome ◽  
Screening Tool ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Multicenter Cohort Study ◽  
Delirium Assessment ◽  
Lengths Of Stay ◽  
History Of

Abstract Background delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients. Objectives to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients. Design a prospective observational multicenter cohort study. Setting four Quebec EDs. Participants independent or semi-independent older patients (age ≥ 65 years) with an ED stay of at least 8 hours that required hospitalisation. Measurements eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium were calculated. Results we enrolled 301 patients (mean age 77 years, 49.5% male, 3.0% with a history of mild dementia). Thirty patients (10.0%) were CAM positive for delirium. Patients had a median of three O3DY assessments. Serial O3DY evaluations to detect delirium among patients with at least one abnormal O3DY had a sensitivity of 86.7% (95% confidence interval—CI 69.3–96.2%) and a specificity of 44.3% (95%; CI 38.3–50.4%). Conclusion serial O3DY testing demonstrates good sensitivity as a screening tool to detect delirium among older adult patients with prolonged ED lengths of stay. Emergency physicians should consider the use of the serial O3DY over clinician gestalt to improve delirium detection.

scholarly journals What delirium detection tools are used in routine clinical practice in the United Kingdom? Survey results from 91% of acute healthcare organisations

2021 ◽  
Author(s):  
Zoë Tieges ◽  
Jacqueline Lowrey ◽  
Alasdair M. J. MacLullich
Keyword(s):  
United Kingdom ◽  
Clinical Practice ◽  
Real World ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Assessment Tools ◽  
Clinical Population ◽  
Detection Methods ◽  
Delirium Assessment ◽  
The United Kingdom

Abstract Purpose Our aim was to collect information on delirium assessment processes and pathways in non-intensive care settings in the United Kingdom (UK). Methods We sent a Freedom of Information request to 169 UK National Health Service (NHS) hospitals, trusts and health boards (units) in July 2020 to obtain data on usage of delirium assessment tools in clinical practice and delirium pathways or guidelines. Results We received responses from 154/169 units (91% response rate). Of these, 146/154 (95%) units reported use of formal delirium assessment processes and 131/154 (85%) units had guidelines or pathways in place. The 4’A’s Test (4AT) was the most widely used tool, with 117/146 (80%) units reporting use. The Confusion Assessment Method was used in 65/146 (45%) units, and the Single Question to identify Delirium (SQiD) in 52/146 (36%) units. Conclusions Our findings show that the 4AT is the most commonly used tool in the UK, with 80% of units reporting use. This study adds to our knowledge of real-world uptake of delirium detection methods at scale. Future studies should evaluate real-world implementation of delirium assessment tools further via (1) tool completion rates and (2) rates of positive scores against the expected of prevalence delirium in the clinical population concerned.

Educational intervention on delirium assessment using confusion assessment method-ICU (CAM-ICU) in a general intensive care unit

2018 ◽  
Vol 27 (21-22) ◽  
pp. 4028-4039 ◽  
Author(s):  
Vimala Ramoo ◽  
Harlinna Abu ◽  
Vineya Rai ◽  
Surindar Kaur Surat Singh ◽  
Ayuni Asma’ Baharudin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Educational Intervention ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
General Intensive Care Unit ◽  
Delirium Assessment ◽  
Confusion Assessment

Assessment and Management of Delirium in Critically Ill Veterans

2020 ◽  
Vol 40 (4) ◽  
pp. 42-52
Author(s):  
Denise M. Kresevic ◽  
Donna Miller ◽  
Carole W. Fuseck ◽  
Mia Wade ◽  
Laura Whitney ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Education Program ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Surgical Intensive Care ◽  
Delirium Assessment ◽  
Confusion Assessment ◽  
Interactive Education

Background Delirium is a complex syndrome prevalent in the intensive care unit. It has been associated with significant morbidity including distress, longer hospital stays, prolonged cognitive impairment, and increased mortality. Objective To describe a nurse-led interdisciplinary quality improvement initiative to increase nurses’ knowledge of delirium, documentation of delirium assessment, and patient mobility. Methods Sixty-seven nurses in medical and surgical intensive care units were required to attend an interactive education program on delirium assessment and management. Scores on tests taken before and after the education program were used to evaluate knowledge. Medical records and bedside rounds were used to validate Confusion Assessment Method for the Intensive Care Unit documentation and interventions. Descriptive statistics were used to describe changes over time. A delirium resource team composed of nurses, physicians, and therapists provided didactic education paired with simulation training and bedside coaching. Mobility screening tests and computer templates guided assessments and interventions. Results Documentation of the Confusion Assessment Method improved from less than 50% to consistently 99%. Mobilization in the surgical intensive care unit increased from 90% to 98% after intervention. Days of delirium significantly decreased from 51% before intervention to 31% after intervention (χ12=7.01, P = .008). Conclusions The success of this quality improvement project to enhance recognition of delirium and increase mobility (critical components of the pain assessment, breathing, sedation choice, delirium, early mobility, and family education bundle) was contingent on nursing leaders hip, interdisciplinary team collaboration, and interactive education.

Evaluation of the delirium early monitoring system (DEMS)

2016 ◽  
Vol 28 (11) ◽  
pp. 1879-1887 ◽  
Author(s):  
Daniel Rippon ◽  
Koen Milisen ◽  
Elke Detroyer ◽  
Elizabeta Mukaetova-Ladinska ◽  
Beth Harrison ◽  
...  
Keyword(s):  
Monitoring System ◽  
Medical Records ◽  
Medical Staff ◽  
Daily Practice ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Secondary Outcome ◽  
Assessment Scores ◽  
Inpatient Settings ◽  
Delirium Management

ABSTRACTBackground:Despite awareness of the negative health and financial outcomes of delirium, systems to routinely assess and manage the condition are absent in clinical practice. We report the development and pilot evaluation of a Delirium Early Monitoring System (DEMS), designed to be completed by non-medical staff to influence clinical processes within inpatient settings. Two versions of the DEMS are described based on a modified Confusion Assessment Method (DEMS-CAM) and Delirium Observation Screening Scale (DEMS-DOSS).Methods:Both versions of DEMS were piloted on a 20-bedded Psychogeriatric ward over 6 weeks. Training was administered to ward staff on the use of each version of the DEMS and data were collected via electronic medical records and completed assessment sheets. The primary outcome was patterns of DEMS use and the secondary outcome was the initiation of delirium management protocols. Data regarding the use of the DEMS DOSS and DEMS CAMS were analyzed using χ2 tests.Results:Completion rates for the DEMS CAM and DEMS DOSS were 79% and 68%, respectively. Non-medical staff were significantly more likely to use the DEMS-CAM as part of daily practice as opposed to the DEMS-DOSS (p<0.001). However, there was no difference between the use of the DEMS-CAM and DEMS-DOSS in triggering related actions such as documentation of assessment scores in patients’ medical records and implementation of delirium management protocols.Conclusions:This real world evaluation revealed that non-medical staff were able to incorporate delirium monitoring into their practice, on the majority of occasions, as part of their daily working routine. Further research is necessary to determine if the routine use of the DEMS can lead to improved understandings and practice of non-medical staff regarding delirium detection.

scholarly journals Reliability and accuracy of delirium assessments among investigators at multiple international centres

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023137 ◽  
Author(s):  
Hannah R Maybrier ◽  
Angela M Mickle ◽  
Krisztina E Escallier ◽  
Nan Lin ◽  
Eva M Schmitt ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Role Playing ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Group Discussions ◽  
Perfect Agreement ◽  
Delirium Assessment ◽  
Video Recordings ◽  
Research Centres ◽  
Training Protocol

IntroductionDelirium is a common, serious postoperative complication. For clinical studies to generate valid findings, delirium assessments must be standardised and administered accurately by independent researchers. The Confusion Assessment Method (CAM) is a widely used delirium assessment tool. The objective was to determine whether implementing a standardised CAM training protocol for researchers at multiple international sites yields reliable inter-rater assessment and accurate delirium diagnosis.MethodsPatients consented to video recordings of CAM delirium assessments for research purposes. Raters underwent structured training in CAM administration. Training entailed didactic education, role-playing with intensive feedback, apprenticeship with experienced researchers and group discussions of complex cases. Raters independently viewed and scored nine video-recorded CAM interviews. Inter-rater reliability was determined using Fleiss kappa. Accuracy was judged by comparing raters’ scores with those of an expert delirium researcher.ResultsTwenty-seven raters from eight international research centres completed the study and achieved almost perfect agreement for overall delirium diagnosis, kappa=0.88 (95% CI 0.85 to 0.92). Agreement of the four core CAM features ranged from fair to substantial. The sensitivity and specificity for identifying delirium were 72% (95% CI 60% to 81%) and 99% (95% CI 96% to 100%), considering an expert rater’s scores as the reference standard (delirious, n=3; non-delirious, n=6). Delirium severity ratings were tightly clustered, with most scores within 5% of the median.ConclusionOur results demonstrate that, with appropriate training and ongoing scoring discussions, researchers at multiple sites can reliably detect delirium in postsurgical patients. These results support the premise that methodologically rigorous multi-centre studies can yield standardised and accurate determinations of delirium.

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