Advantages of score-based delirium detection compared to a clinical delirium assessment—a retrospective, monocentric cohort study

Titel:	Advantages of score-based delirium detection compared to a clinical delirium assessment—a retrospective, monocentric cohort study
Verfasser:	Jäckel, Markus ; Aicher, Nico ; Bemtgen, Xavier ; Rilinger, Jonathan ; Zotzmann, Viviane ; Biever, Paul ; Supady, Alexander ; Stachon, Peter ; Dürschmied, Daniel Frank ; Wengenmayer, Tobias ; Bode, Christoph ; Staudacher, Dawid
Veröffentlicht:	Freiburg : Universität, 2021
Umfang:	1 Online-Ressource
Format:	E-Book
Sprache:	Englisch

Bemerkung:	PLOS ONE. - 16, 11 (2021) , e0259841, ISSN: 1932-6203
Zusammenfassung:	Abstract: Purpose<br>Delirium is an underdiagnosed complication on intensive care units (ICU). We hypothesized that a score-based delirium detection using the Nudesc score identifies more patients compared to a traditional diagnosis of delirium by ICU physicians.<br><br>Methods<br>In this retrospective study, all patients treated on a general medical ICU with 30 beds in a university hospital in 2019 were analyzed. Primary outcome was a documented physician diagnosis of delirium, or a delirium score ≥2 using the Nudesc.<br><br>Results<br>In 205/943 included patients (21.7%), delirium was diagnosed by ICU physicians compared to 438/943 (46.4%; ratio 2.1) by Nudesc≥2. Both assessments were independent predictors of ICU stay (p<0.01). The physician diagnosis however was no independent predictor of mortality (OR 0.98 (0.57–1.72); p = 0.989), in contrast to the score-based diagnosis (OR 2.31 (1.30–4.10); p = 0.004). Subgroup analysis showed that physicians underdiagnosed delirium in case of hypoactive delirium and delirium in patients with female gender and in patients with an age below 60 years.<br><br>Conclusion<br>Delirium in patients with hypoactive delirium, female patients and those below 60 years was underdiagnosed by physicians. The score-based delirium diagnosis detected delirium more frequently and correlated with ICU mortality and stay

Bemerkung:

PLOS ONE. - 16, 11 (2021) , e0259841, ISSN: 1932-6203

Zusammenfassung:

Abstract: Purpose Delirium is an underdiagnosed complication on intensive care units (ICU). We hypothesized that a score-based delirium detection using the Nudesc score identifies more patients compared to a traditional diagnosis of delirium by ICU physicians. Methods In this retrospective study, all patients treated on a general medical ICU with 30 beds in a university hospital in 2019 were analyzed. Primary outcome was a documented physician diagnosis of delirium, or a delirium score ≥2 using the Nudesc. Results In 205/943 included patients (21.7%), delirium was diagnosed by ICU physicians compared to 438/943 (46.4%; ratio 2.1) by Nudesc≥2. Both assessments were independent predictors of ICU stay (p<0.01). The physician diagnosis however was no independent predictor of mortality (OR 0.98 (0.57–1.72); p = 0.989), in contrast to the score-based diagnosis (OR 2.31 (1.30–4.10); p = 0.004). Subgroup analysis showed that physicians underdiagnosed delirium in case of hypoactive delirium and delirium in patients with female gender and in patients with an age below 60 years. Conclusion Delirium in patients with hypoactive delirium, female patients and those below 60 years was underdiagnosed by physicians. The score-based delirium diagnosis detected delirium more frequently and correlated with ICU mortality and stay