Intensive Care Delirium Screening Checklist: evaluation of a new screeningtool

Objective: Delirium in the intensive care unit is poorly defined. Clinical evaluation is difficult in the setting of unstable, often intubated patient s. A screening tool may improve the detection of delirium. Method: We created a screening checklist of eight items based on DSM criter ia and features of delirium: altered level of consciousness, inattention, d isorientation, hallucination or delusion, psychomotor agitation or retardat ion, inappropriate mood or speech, sleep/wake cycle disturbance, and sympto m fluctuation. During 3 months, all patients admitted to a busy medical/sur gical intensive care unit were evaluated, and the scale score was compared to a psychiatric evaluation. Results: In 93 patients studied, 15 developed delirium. Fourteen (93%) of t hem had a score of 4 points or more. This score was also present in 15 (19% ) of patients without delirium, 14 of whom had a known psychiatric illness, dementia, a structural neurological abnormality or encephalopathy. A ROC a nalysis was used to determine the sensitivity and specificity of the screen ing tool. The area under the ROC curve is 0.9017. Predicted sensitivity is 99% and specificity is 64%. Conclusion: This study suggests that the Intensive Care Delirium Screening Checklist can easily be applied by a clinician or a nurse in a busy critica l care setting to screen all patients even when communication is compromise d. The tool can be utilized quickly and helps to identify delirious patient s. Earlier diagnosis may lead to earlier intervention and better patient ca re.