Identifying Delirium
In routine practice, ICU staff members typically
do not diagnose delirium in almost three quarters
of their patients who have the condition,
whereas active screening by research nurses
identified delirium in up to 64% of patients who
were considered to be delirious by a psychiatrist,
a geriatrician, or a neurologist Scales with respect
to delirium in the ICU apply the four DSM-IV
domains defining delirium in general medical
and psychiatric patients to those in the ICU whose
severity of illness can rapidly fluctuate, who receive
multiple analgesics and sedatives, and who
are unable to speak owing to endotracheal intubation.
Two scales are in common use, the Confusion
Assessment Method for the ICU (CAM-ICU)41
and the Intensive Care Delirium Screening Checklist
(ICDSC)29 (Table 3). The CAM-ICU reports a
dichotomous assessment at a single time point,
whereas the ICDSC lists signs that can be observed
over a period of time. Although such scales dichotomize delirium as being either present
or absent, although it would seem to be intuitive
that delirium has different degrees of severity.
The CAM-ICU and ICDSC are currently the
two accepted methods for identifying a condition
that otherwise frequently goes undiagnosed.