Delirium screening for patients in the intensive care unit: A prospective validation study of the iCAM-ICU by nurse researchers and bedside nurses in routine practice
Section snippets
Background
Delirium is one of the most common complications among patients in the intensive care unit (ICU). The reported incidence for delirium ranged about 20% to 50% for nonmechanically ventilated patients, and 60% to 80% for mechanically ventilated critically ill patients in ICU settings (Krewulak et al., 2018; Ely et al., 2001). ICU patients complicated with delirium are predisposed to adverse outcomes, including prolonged ICU and hospital stay, impaired cognitive function, increased in-hospital and
Methods
This study employed a two-phase prospective cohort study design. The institutional review committee of the study hospital (university affiliated hospital) approved this study before it was initiated. The study was registered at the Chinese Clinical Trial website (ChiCTR-OCH-13003050), and written informed consent was provided from patient themselves before their enrollment.
Basic patient characteristics in phase I
In phase I, a total of 240 patients admitted to the 4 ICUs were screened and 181 patients were finally enrolled in this phase (See Fig. 1).
As shown in Table 1, among 181 patients enrolled in phase I, 63 patients were identified as delirium-positive while 118 were as delirium-negative according to the results made by experts against the reference standard. The mean age of patients included in phase I were 70 (SD = 10) years old, and there were about half of patients being male (52.4%) and with
Discussion
In this study, we conducted a two-phase diagnostic testing of the iCAM-ICU in ICU patients among both nurse investigators (phase I) and bedside nurses (phase II) in against the gold standard. To the best of our knowledge, this was the first study in which an interactive mobile application based on the CAM-ICU algorithm with decision-making support was created and tested for accuracy in ICU settings, among nursing investigators and ICU bedside nurses. The results of our study showed good
Strengths and limitations
In our study, we incorporated information technology assisted decision-making support to assist ICU nurses identifying delirium correctly during routine practice. As indicated in previous research, the CAM-ICU paper version has been reported with low sensitivities among bedside nurses (Nishimura et al., 2016; Boettger et al., 2018), this limited its application and reduced its beneficial effect for patients in routine practice. Our study utilized information technology to overcome these
Conclusions
In conclusion, the iCAM-ICU, an intelligent and interactive screening tool for delirium based on the CAM-ICU, can assist bedside nurses to detect delirium reliably. It is identified with high sensitivity and specificity in ICU patients including those with different clinical characteristics. Future studies are needed to evaluate the effect of routine delirium assessment using iCAM-ICU on delirium related clinical outcomes and explore its effect for delirium prevention.
CRediT authorship contribution statement
All authors approved the final version of the manuscript for submission.
Ying Wu setup the protocol, conceptualization, carried out the design and development of the “iCAM-ICU”, oversaw the collection, analysis and interpretation of the data, and critically reviewed and revised the manuscript. Fangyu Yang drafted the protocol, carried out the design and development of “iCAM-ICU”, participated in data collection, analysis and performed statistical analysis, as well as development of the
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
In the development stage of iCAM-ICU, interface outline, flow chart and process based on CAM-ICU were provided by our team, and the group from Beijing Jian Yue Times Technology Co., Ltd. assisted us in the actual development of the application, such as programming, developing and refining the application, but had no
Acknowledgment
We would like to acknowledge the following group or people who have made contributions to the current study. In the process of system development and clinical research, Beijing Jian Yue Times Technology Co., Ltd. provided technology support and realized the iCAM-ICU design. iPads used for delirium assessment were provided by the Shenda group. During our study, we received support from Chaoyang Hospital and Xuanwu Hospital (affiliated hospitals with Capital Medical University) by giving us
Funding
This study was supported by the National Natural Science Foundation of China (#30871049, Principal Investigator: Dr. Ying Wu).
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Authors contributed equally to the publication of the manuscript.