Assessment of Delirium and Depression in the ICU

This presentation is part of : Strategies in Critical Care

Bette K. Idemoto, PhD, RN, Medical/Surgical Nursing, University Hospitals of Cleveland, Cleveland, OH, USA and Barbara J. Daly, PhD, RN, FAAN, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.

The purpose of the study was to examine the accuracy of critical care nurses’ clinical assessment of delirium and depression compared to standardized validated tools. Studies have shown high incidence, poor outcomes and long-term sequelae for ICU patients who experience delirium or depression. Timely and appropriate treatment of these problems relies on accurate identification of symptoms by the nurse, but the incidence is often underestimated by critical care clinicians.

126 adult post-operative patients in the Surgical ICU of a large urban medical center were assessed using: the Confusion Assessment Method-ICU (CAM-ICU) for delirium, and the Hospital Anxiety and Depression Scale (HADS-D) to assess depression. Results of these tools were compared to the informal clinical assessment of the nurses caring for the patients on the day of interview.

Following study completion, data examined showed fair to average concordance. Percent agreement was 84.9% with a Kappa value .546 (p<.001) for delirium; and 80.9% agreement with a Kappa value .219 (p=.029) for depression. Logistic regression was used to assess the influence of patient characteristics (age, gender, race, hospital day of interview, and primary procedure or diagnosis) and nurse characteristics (RN gender, educational preparation, years of nursing experience) to assess the accuracy of the nurses’ judgment. The regression model for depression was significant with hospital day (OR 1.119, p=.02) and RN years of experience (OR .725, p-.03) as predictors of concordance; the regression model for delirium was not significant.

Conclusions: This SICU study is the first to assess ICU nurses’ accuracy of detection of delirium and depression in post-operative ICU patients. Clinically, nurses’ accuracy in detection of these syndromes could be improved to optimize the critically ill patient management and outcomes. Implementing the use of simple validated screening tools should be studied to demonstrate improvement in assessment and potentially to improve outcomes.

Learning Objective #1: discuss clinical presentations of delirium and depression in the post-operative ICU patient
Learning Objective #2: discuss the accuracy of critical care nurses’ clinical assessment of delirium and depression compared to standardized validated tools.