Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, 88806-000 Criciúma, SC, Brazil.
J Crit Care. 2012 Apr;27(2):212-7. doi: 10.1016/j.jcrc.2011.05.015. Epub 2011 Jul 6.
Delirium is a frequent and serious problem in the intensive care unit (ICU) that is associated with increased mortality, prolonged mechanical ventilation, and prolonged hospital length of stay (LOS). The main objective of the present study was to compare and assess the agreement between the diagnosis of delirium obtained by the Confusion Assessment Method for the ICU (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) in patients admitted to the ICU and their association with outcomes.
Adult patients admitted to the ICU for more than 24 hours between May and November 2008 were included. Patients with a Richmond Agitation-Sedation Scale score of -4 to -5 for more than 3 days were excluded. Delirium was evaluated twice a day by the ICDSC and CAM-ICU. Patients were followed-up until ICU discharge or for a maximum of 28 days.
During the study period, 383 patients were admitted to the ICU and 162 (42%) were evaluated; delirium was identified in 26.5% of patients by CAM-ICU and in 34.6% by ICDSC. There was agreement in diagnosing delirium diagnosis between the 2 methods in 42 (27.8%) patients and in excluding delirium in 105 (64.8%) patients. The ICDSC was positive in 14 (8.6%) patients in whom CAM-ICU was negative. Delirium, diagnosed either by ICDSC or CAM-ICU assessments, was associated with both significantly increased hospital LOS (14.8 ± 8.3 vs 9.8 ± 6.4, P < .001; 15.3 ± 8.7 vs 10.5 ± 7.1, P < .001, respectively), mortality in the ICU (11.1% vs 5.8%, P < .001; 12.5% vs 2.5%, P = .022), and in the hospital (10.7% vs 5.6%, P < .001; 23.2% vs 10.9%, P = .047). In addition, patients with positive ICDSC presenting with negative CAM-ICU had similar outcomes as compared with those without delirium.
The findings of our study suggest that the CAM-ICU is better predictor of outcome when compared with ICDSC.
谵妄是重症监护病房（ICU）中常见且严重的问题，与死亡率增加、机械通气时间延长和住院时间延长有关。本研究的主要目的是比较和评估通过 ICU 意识模糊评估法（CAM-ICU）和 ICU 意识混乱筛查检查表（ICDSC）诊断 ICU 患者谵妄的一致性，并评估其与结局的关系。
纳入 2008 年 5 月至 11 月期间入住 ICU 超过 24 小时的成年患者。排除持续 3 天以上 Richmond 意识-镇静量表评分为-4 至-5 的患者。每天两次通过 ICDSC 和 CAM-ICU 评估谵妄。对患者进行随访，直至 ICU 出院或最长 28 天。
研究期间，383 名患者入住 ICU，其中 162 名（42%）接受了评估；CAM-ICU 诊断谵妄的患者占 26.5%，ICDSC 诊断的患者占 34.6%。两种方法在 42 名（27.8%）患者中诊断谵妄的结果一致，在 105 名（64.8%）患者中排除谵妄的结果一致。CAM-ICU 阴性而 ICDSC 阳性的患者有 14 例（8.6%）。通过 ICDSC 或 CAM-ICU 评估诊断为谵妄的患者均与 ICU 住院时间延长（14.8 ± 8.3 比 9.8 ± 6.4，P <.001；15.3 ± 8.7 比 10.5 ± 7.1，P <.001）、ICU 死亡率（11.1%比 5.8%，P <.001；12.5%比 2.5%，P =.022）和住院死亡率（10.7%比 5.6%，P <.001；23.2%比 10.9%，P =.047）显著相关。此外，与无谵妄患者相比，ICDSC 阳性而 CAM-ICU 阴性的患者具有相似的结局。
与 ICDSC 相比，CAM-ICU 是一种更好的预后预测指标。
