Kontakt 2022, 24(1):36-42 | DOI: 10.32725/kont.2022.006

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

Hana Locihová1, 2, 3, *, Jana Pelikánová4
1 University of Ostrava, Faculty of Medicine, Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Ostrava, Czech Republic
2 AGEL Educational and Research Institute (VIA), Prostějov, Czech Republic
3 AGEL Secondary Nursing School and Higher Nursing School, Ostrava, Czech Republic
4 AGEL Hospital Valašské Meziříčí, Valašské Meziříčí, Czech Republic

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.

Keywords: Acute nursing; CAM-ICU; Delirium; Intensive Care Unit; NEECHAM Confusion Scale; Non-intubated patients
Grants and funding:

The study was supported by AGEL internal grant, project no.: INT 2019003

Conflicts of interest:

The authors declare that there is no conflict of interest regarding the study and that ethical aspects were considered while processing the results. All literature sources were properly cited.

Received: July 18, 2021; Revised: December 1, 2021; Accepted: January 24, 2022; Prepublished online: March 3, 2022; Published: March 15, 2022  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Locihová H, Pelikánová J. 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. Kontakt. 2022;24(1):36-42. doi: 10.32725/kont.2022.006.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Ashtarian H, Mehrabi N, Bazrafshan MR, Rahmati M (2019). Validation of the NEECHAM confusion scale for intensive care delirium assessment. J Health Sci Surveill Sys 7(4): 178-182. DOI: 10.30476/JHSSS.2020.85687.1073. Go to original source...
    2. Balková M, Tomagová M (2018). Use of measurement tools for screening of postoperative delirium in nursing practice. Cent Eur J Nurs Midw 9(3): 897-904. DOI: 10.15452/CEJNM.2018.09.0021. Go to original source...
    3. Černá Pařízková R (2019). Delirium v intenzivní péči. Vnitr Lek 65(6): 433-439. DOI: 10.36290/vnl.2019.077. Go to original source... Go to PubMed...
    4. Cherak SJ, Soo A, Brown KN, Ely EW, Stelfox HT, Fiest KM (2020). Development and validation of delirium prediction model for critically ill adults parameterized to ICU admission acuity. PloS One 15(8): e0237639. DOI: 10.1371/journal.pone.0237639. Go to original source... Go to PubMed...
    5. Cribbin D (2018). Review: Communication with invasive mechanically ventilated patients and the use of alternative devices: integrative review. J Res Nurs 23(7): 631-632. DOI: 10.1177/1744987118786142. Go to original source... Go to PubMed...
    6. Devlin JW, Fong JJ, Fraser GL, Riker RR (2007). Delirium assessment in the critically ill. Intensive Care Med 33(6): 929-940. DOI: 10.1007/s00134-007-0603-5. Go to original source... Go to PubMed...
    7. Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter A, Pandharipande PP, et al. (2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 46(9): e825-e873. DOI: 10.1097/CCM.0000000000003299. Go to original source... Go to PubMed...
    8. Dušek L, Pavlík T, Jarkovský J, Koptíková J (2011). Analýza dat v neurologii XXIX. - Spolehlivost (reliabilita) klinických testů. Cesk Slov Neurol N 74/107(5): 594-599.
    9. Grover S, Kate N (2012). Assessment scales for delirium: a review. World J Psychiatry 2(4):58-70. DOI: 10.5498/wjp.v2.i4.58. Go to original source... Go to PubMed...
    10. Guillory J, Fitz-Gerald C, Banik A, Sterwald C, Ashiofu E, Knox E, et al. (2021). Comparison of hospital course and outcome in hospital-acquired vs pre-existing delirium. Ann Clin Psychiatry 33(1): 35-44. DOI: 10.12788/acp.0021. Go to original source... Go to PubMed...
    11. Gusmao-Flores D, Salluh JIF, Chalhub RÁ, Quarantini LC (2012). The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Crit Care 16(4): R115. DOI: 10.1186/cc11407. Go to original source... Go to PubMed...
    12. Helgesen AK, Adan YH, Dybvik Bjørglund C, Weberg-Haugen C, Johannessen M, Åsmul Kristiansen K et al. (2021). Nurses' experiences of delirium and how to identify delirium - a qualitative study. Nurs Open 8: 844-849. DOI: 10.1002/nop2.691. Go to original source... Go to PubMed...
    13. Ho MH, Montgomery A, Traynor V, Chang CC, Kuo KN, Chang HR, et al. (2020). Diagnostic performance of delirium assessment tools in critically ill patients: A systematic review and meta-Analysis. Worldviews Evid Based Nurs 17(4): 301-310. DOI: 10.1111/wvn.12462. Go to original source... Go to PubMed...
    14. Immers HE, Schuurmans MJ, van de Bijl JJ (2005). Recognition of delirium in ICU patients: a diagnostic study of theNEECHAM confusion scale in ICU patients. BMC Nurs 4(1): 7. DOI: 10.1186/1472-6955-4-7. Go to original source... Go to PubMed...
    15. Káňová M, Burda M, Povová J, Neiser J (2015). Delirium u kriticky nemocných - prospektivní studie. Cesk Slov Neurol N 78(6): 662-667.
    16. Matarese M, Generoso S, Ivziku D, Pedone C, De Marinis MG (2013). Delirium in older patients: a diagnostic study of NEECHAM Confusion Scale in surgical intensive care unit. J Clin Nurs 22(19-20): 2849-2857. DOI: 10.1111/j.1365-2702.2012.04300.x. Go to original source... Go to PubMed...
    17. Matsushita T, Matsushima E, Maruyama M (2004). Early detection of postoperative delirium and confusion in a surgical ward using the NEECHAM confusion scale. Gen Hosp Psychiatry 26(2): 158-163. DOI: 10.1016/j.genhosppsych.2003.08.011. Go to original source... Go to PubMed...
    18. Milisen K, Foreman MD, Hendrickx A, Godderis J, Abraham IL, Broos PL, et al. (2005). Psychometric properties of the Flemish translation of the NEECHAM Confusion Scale. BMC Psychiatry 5: 16. DOI: 10.1186/1471-244X-5-16. Go to original source... Go to PubMed...
    19. Mitášová A, Bednařík J, Košťálová M, Michalčáková R, Ježková M, Kašpárek T, et al. (2010). Standardizace české verze The Confusion Assessment Method for the Intensive Care Unit (CAM-ICUcz). Cesk Slov Neur N 73/106 (3): 258-266.
    20. Neelon VJ, Champagne MT, Carlson JR, Funk SG (1996). The NEECHAM Confusion Scale: construction, validation, and clinical testing. Nurs Res 45(6): 324-330. DOI: 10.1097/00006199-199611000-00002. Go to original source... Go to PubMed...
    21. Poikajärvi S, Salanterä S, Katajisto J, Junttila K (2017). Validation of Finnish Neecham Confusion Scale and Nursing Delirium Screening Scale using Confusion Assessment Method algorithm as a comparison scale. BMC Nursing 16: 7. DOI: 10.1186/s12912-016-0199-6. Go to original source... Go to PubMed...
    22. Pun BT, Ely EW (2007). The importance of diagnosing and managing ICU delirium. Chest 132(2): 624-636. DOI: 10.1378/chest.06-1795. Go to original source... Go to PubMed...
    23. Rowley-Conwy G (2018). Barriers to delirium assessment in the intensive care unit: A literature review. Intensive Crit Care Nurs 44: 99-104. DOI: 10.1016/j.iccn.2017.09.001. Go to original source... Go to PubMed...
    24. Serafim RB, Soares M, Bozza FA, Lapa E Silva JR, Dal-Pizzol F, Paulino MC, et al. (2017). Outcomes of subsyndromal delirium in ICU: a systematic review and meta-analysis. Crit Care 21(1): 179. DOI: 10.1186/s13054-017-1765-3. Go to original source... Go to PubMed...
    25. Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Elseviers M, Bossaert L (2008). A comparison of the CAM-ICU and the NEECHAM Confusion Scale in intensive care delirium assessment: an observational study in non-intubated patients. Crit Care 12(1): R16. DOI: 10.1186/cc6790. Go to original source... Go to PubMed...
    26. Waterfield D, Barnason S (2021). Use of PADIS assessment tools by critical care nurses: An integrative review. West J Nurs Res 43(9): 843-858. DOI: 10.1177/0193945920973025. Go to original source... Go to PubMed...
    27. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. (2005). Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health 8(2): 94-104. DOI: 10.1111/j.1524-4733.2005.04054.x. Go to original source... Go to PubMed...
    28. Zhang Z, Pan L, Ni H. (2013). Impact of delirium on clinical outcome in critically ill patients: a meta-analysis. Gen Hosp Psychiatry 35(2): 105-111. DOI: 10.1016/j.genhosppsych.2012.11.003. Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content