Comparing the Confusion Assessment Method for the Intensive Care Unit and Neelon and Champagne Confusion Scale for assessing delirium in non-intubated intensive care patients

Abstract

Introduction: There are many scales of assessment and prediction of risk of delirium, but they are little known and rarely used by professionals. Recognition of delirium by nurses continues to be limited. Design: The prospective observational study included 50 consecutive non-intubated patients staying in the ICU for more than 24 hours. Setting: Department of anesthesiology and intensive care medicine (5 beds) of AGEL Hospital in Valašské Meziříčí, between September 2020 and March 2021. Methods: Primary outcome was to compare the presence of delirium in non-intubated ICU patients with two simultaneously used assessment tools: the Neelon and Champagne (NEECHAM) Confusion Scale, and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). A secondary outcome was to verify the NEECHAM Confusion Scale reliability in the Czech ICU setting. Results: The study found that the incidence rates detected by the CAM-ICU (32%) and NEECHAM Confusion Scale (28%) were comparable. Nearly a third of CAM-ICU-negative patients were found to belong to the mild confusion or at-risk NEECHAM Confusion Scale groups. The internal consistency of the NEECHAM Confusion Scale assessed with Cronbach’s α was 0.703. There was a statistically significant relationship between delirium and two of the studied patient parameters (GCS score and use of antipsychotics). Conclusions: Delirium is common in ICU patients, but it often remains undiagnosed. Various tools have been developed to help identify delirium patients. Their use has been shown to result in better outcomes. Both studied tools (the CAM-ICU and NEECHAM Confusion Scale) appear to be suitable and convenient.