Kirsten M Fiest, Karla D Krewulak1, E Wesley Ely2, Judy E Davidson3, Zahinoor Ismail4,5,6, Bonnie G Sept1, Henry T Stelfox1,4. 1. Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada. 2. Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (VA GRECC), Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN. 3. Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA. 4. Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada. 5. Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. 6. Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
Abstract
OBJECTIVES: To evaluate the diagnostic accuracy of family-administered tools to detect delirium in critically ill patients. DESIGN: Diagnostic accuracy study. SETTING: Large, tertiary care academic hospital in a single-payer health system. PATIENTS: Consecutive, eligible patients with at least one family member present (dyads) and a Richmond Agitation-Sedation Scale greater than or equal to -3, no primary direct brain injury, the ability to provide informed consent (both patient and family member), the ability to communicate with research staff, and anticipated to remain admitted in the ICU for at least a further 24 hours to complete all assessments at least once. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Family-administered delirium assessments (Family Confusion Assessment Method and Sour Seven) were completed once daily. A board-certified neuropsychiatrist and team of ICU research nurses conducted the reference standard assessments of delirium (based on Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, criteria) once daily for a maximum of 5 days. The mean age of the 147 included patients was 56.1 years (SD, 16.2 yr), 61% of whom were male. Family members (n = 147) were most commonly spouses (n = 71, 48.3%) of patients. The area under the receiver operating characteristic curve on the Family Confusion Assessment Method was 65.0% (95% CI, 60.0-70.0%), 71.0% (95% CI, 66.0-76.0%) for possible delirium (cutpoint of 4) on the Sour Seven and 67.0% (95% CI, 62.0-72.0%) for delirium (cutpoint of 9) on the Sour Seven. These area under the receiver operating characteristic curves were lower than the Intensive Care Delirium Screening Checklist (standard of care) and Confusion Assessment Method for ICU. Combining the Family Confusion Assessment Method or Sour Seven with the Intensive Care Delirium Screening Checklist or Confusion Assessment Method for ICU resulted in area under the receiver operating characteristic curves that were not significantly better, or worse for some combinations, than the Intensive Care Delirium Screening Checklist or Confusion Assessment Method for ICU alone. Adding the Family Confusion Assessment Method and Sour Seven to the Intensive Care Delirium Screening Checklist and Confusion Assessment Method for ICU improved sensitivity at the expense of specificity. CONCLUSIONS: Family-administered delirium detection is feasible and has fair, but lower diagnostic accuracy than clinical assessments using the Intensive Care Delirium Screening Checklist and Confusion Assessment Method for ICU. Family proxy assessments are essential for determining baseline cognitive function. Engaging and empowering families of critically ill patients warrant further study.
OBJECTIVES: To evaluate the diagnostic accuracy of family-administered tools to detect delirium in critically illpatients. DESIGN: Diagnostic accuracy study. SETTING: Large, tertiary care academic hospital in a single-payer health system. PATIENTS: Consecutive, eligible patients with at least one family member present (dyads) and a Richmond Agitation-Sedation Scale greater than or equal to -3, no primary direct brain injury, the ability to provide informed consent (both patient and family member), the ability to communicate with research staff, and anticipated to remain admitted in the ICU for at least a further 24 hours to complete all assessments at least once. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Family-administered delirium assessments (Family Confusion Assessment Method and Sour Seven) were completed once daily. A board-certified neuropsychiatrist and team of ICU research nurses conducted the reference standard assessments of delirium (based on Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, criteria) once daily for a maximum of 5 days. The mean age of the 147 included patients was 56.1 years (SD, 16.2 yr), 61% of whom were male. Family members (n = 147) were most commonly spouses (n = 71, 48.3%) of patients. The area under the receiver operating characteristic curve on the Family Confusion Assessment Method was 65.0% (95% CI, 60.0-70.0%), 71.0% (95% CI, 66.0-76.0%) for possible delirium (cutpoint of 4) on the Sour Seven and 67.0% (95% CI, 62.0-72.0%) for delirium (cutpoint of 9) on the Sour Seven. These area under the receiver operating characteristic curves were lower than the Intensive Care Delirium Screening Checklist (standard of care) and Confusion Assessment Method for ICU. Combining the Family Confusion Assessment Method or Sour Seven with the Intensive Care Delirium Screening Checklist or Confusion Assessment Method for ICU resulted in area under the receiver operating characteristic curves that were not significantly better, or worse for some combinations, than the Intensive Care Delirium Screening Checklist or Confusion Assessment Method for ICU alone. Adding the Family Confusion Assessment Method and Sour Seven to the Intensive Care Delirium Screening Checklist and Confusion Assessment Method for ICU improved sensitivity at the expense of specificity. CONCLUSIONS: Family-administered delirium detection is feasible and has fair, but lower diagnostic accuracy than clinical assessments using the Intensive Care Delirium Screening Checklist and Confusion Assessment Method for ICU. Family proxy assessments are essential for determining baseline cognitive function. Engaging and empowering families of critically illpatients warrant further study.
Authors: Samiha Mohsen; Stephana J Moss; Filipe Lucini; Karla D Krewulak; Henry T Stelfox; Daniel J Niven; Khara M Sauro; Kirsten M Fiest Journal: Crit Care Med Date: 2022-08-26 Impact factor: 9.296
Authors: Filipe R Lucini; Karla D Krewulak; Kirsten M Fiest; Sean M Bagshaw; Danny J Zuege; Joon Lee; Henry T Stelfox Journal: J Am Med Inform Assoc Date: 2021-03-01 Impact factor: 4.497
Authors: Kirsten M Fiest; Karla D Krewulak; Bonnie G Sept; Krista L Spence; Judy E Davidson; E Wesley Ely; Andrea Soo; Henry T Stelfox Journal: BMC Health Serv Res Date: 2020-05-24 Impact factor: 2.655
Authors: Brianna K Rosgen; Karla D Krewulak; Judy E Davidson; E Wesley Ely; Henry T Stelfox; Kirsten M Fiest Journal: BMC Psychiatry Date: 2021-04-09 Impact factor: 3.630
Authors: Therese G Poulin; Karla D Krewulak; Brianna K Rosgen; Henry T Stelfox; Kirsten M Fiest; Stephana J Moss Journal: BMC Health Serv Res Date: 2021-11-05 Impact factor: 2.655
Authors: Stephana J Moss; Karla D Krewulak; Henry T Stelfox; Scott B Patten; Christopher J Doig; Jeanna Parsons Leigh; Kirsten M Fiest Journal: PLoS One Date: 2022-09-27 Impact factor: 3.752
Authors: Kyla N Brown; Andrea Soo; Peter Faris; Scott B Patten; Kirsten M Fiest; Henry T Stelfox Journal: Crit Care Date: 2020-07-31 Impact factor: 9.097