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Delirio , Tamizaje Masivo , Directivas Anticipadas , Delirio/diagnóstico , Humanos , PsicometríaRESUMEN
BACKGROUND: Delirium is one of the most common complications among elderly hospitalized patients, postoperative patients and patients on intensive care units with a prevalence between 11 and 80%. Delirium is associated with higher morbidity and mortality. Reliable instruments are required to detect delirium at an early time point. The Nursing-Delirium Screening Scale (Nu-DESC) is a screening tool with high sensitivity and good specificity. However, there is currently no official translation after ISPOR guidelines of any Danish delirium assessment tools available. Thereby hampering the implementation of 2017 ESA-Guidelines on postoperative Delirium in the clinical routine. The aim of this study is to provide an official translation and evaluation of the Nu-DESC into Danish following the ISPOR process. METHODS: The Nu-DESC was translated after International Society for Pharmacoecomonics and Outcome Research (ISPOR) guidelines to Danish after permission of the original author, and is evaluated by medical staff and finally approved by the original author. RESULTS: All steps of the ISPOR guideline were consecutively followed, without any major problems. The evaluation of the Nu-DESC DK regarding its intelligibility and feasibility showed no statistically significant differences between nurses and medical doctors ratings. The translation was authorized and approved by the original author. CONCLUSION: This study provides the Nu-DESC DK, an official Danish delirium screening instrument, which can detect all psychomotor types of delirium.
RESUMEN
CONTEXT: Delirium is a common, distressing neuropsychiatric complication for patients in palliative care settings, where the need to minimize burden yet accurately assess delirium is hugely challenging. OBJECTIVES: This review focused on the optimal clinical and research application of delirium assessment tools and methods in palliative care settings. METHODS: In addition to multidisciplinary input from delirium researchers and other relevant stakeholders at an international meeting, we searched PubMed (1990-2012) and relevant reference lists to identify delirium assessment tools used either exclusively or partly in the context of palliative care. RESULTS: Of the 26 delirium scales identified, we selected six for in-depth review: three screening tools, two severity measures, and one research tool for neuropsychological assessment of delirium. These tools differed regarding intended use, ease of use, training requirements, psychometric properties, and validation in or suitability for palliative care populations. The Nursing Delirium Screening Scale, Single Question in Delirium, or Confusion Assessment Method, ideally with a brief attention test, can effectively screen for delirium. Favoring inclusivity, use of Diagnostic and Statistical Manual of Mental Disorders-IV criteria gives the best results for delirium diagnosis. The Revised Delirium Rating Scale and the Memorial Delirium Assessment Scale are the best available options for monitoring severity, and the Cognitive Test for Delirium provides detailed neuropsychological assessment for research purposes. CONCLUSION: Given the unique characteristics of patients in palliative care settings, further contextually sensitive studies of delirium assessment are required in this population.
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Delirio/diagnóstico , Cuidados Paliativos/métodos , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Humanos , Hipnóticos y Sedantes/uso terapéutico , Pruebas Neuropsicológicas , Escalas de Valoración PsiquiátricaRESUMEN
EXPERIÊNCIA E OBJETIVOS: O objetivo desse estudo foi validar a versão portuguesa da escala Nursing Delirium Screening Scale (Nu-DESC) para uso em anbientes de terapia intensiva. MÉTODOS: Simultânea e independentemente, avaliamos para ocorrência de delírio todos os pacientes pós-operatórios internados em uma Unidade de Terapia Intensiva Cirúrgica (UTIC) ao longo de um período de um mês, utilizando as versões portuguesas de Nu-DESC e da escala Intensive Care Delirium Screening Checklist (ICDSC) dentro de 24 horas a contar da internação, tanto pelo médico da equipe de pesquisa como pelo enfermeiro diretamente encarregado do paciente. Determinamos a acurácia diagnóstica de Nu-DESC utilizando análises de sensibilidade, especificidade e da curva ROC. Avaliamos a confiabilidade entre enfermeiros/médico da equipe de pesquisa para Nu-DESC pelo coeficiente de correlação intraclasse (CCI). Avaliamos concordância e confiabilidade entre Nu-DESC e ICDSC por percentuais globais e específicos de concordância, e por estatística kappa. RESULTADOS: Com base na escala ICDSC, diagnosticamos delírio em 12 dos 78 pacientes. Para o escore Nu-DESC total, consideramos como alta a confiabilidade entre enfermeiros/médico da equipe. Quanto ao diagnóstico, consideramos perfeita a concordância entre enfermeiros e médico da equipe. O percentual de concordância global entre Nu-DESC e ICDSC para o diagnóstico de delírio foi 0,88, e kappa variou de 0,79 a 0,93. A sensibilidade da escala Nu-DESC foi 100%, e a especificidade, 86%. CONCLUSÕES: A versão portuguesa da escala Nu-DESC parece ser instrumento de avaliação e monitoramento acurado e confiável para o diagnóstico de delírio em ambientes de terapia intensiva.
BACKGROUND AND OBJECTIVES: The aim of this study was to validate the Portuguese version of the Nursing Delirium Screening Scale (Nu-DESC) for use in critical care settings. METHODS: We simultaneously and independently evaluated all postoperative patients admitted to a surgical Intensive Care Unit (SICU) over a 1-month period for delirium, using the Portuguese versions of both the Nu-DESC and the Intensive Care Delirium Screening Checklist (ICDSC) within 24 hours of admission by both the research staff physician and one bedside nurse. We determined the diagnostic accuracy of the Nu-DESC using sensitivity, specificity and ROC curve analyses. We assessed reliability between nurses and the research staff physician for Nu-DESC by intraclass correlation coefficient (ICC). We assessed agreement and reliability between Nu-DESC and ICDSC by overall and specific proportions of agreement and by kappa statistics. RESULTS: Based on the ICDSC, we diagnosed delirium in 12 of the 78 patients. Reliability between nurses and the staff physician for total Nu-DESC score was high. Agreement between nurses and staff physician in the delirium diagnosis was perfect. The proportion of overall agreement between Nu-DESC and ICDSC in the delirium diagnosis was 0.88 and the kappa ranged from 0.79 to 0.93. Nu-DESC Sensitivity was 100 and specificity was 86%. CONCLUSIONS: The Portuguese version of the Nu-DESC appears to be an accurate and reliable assessment and monitoring instrument for delirium in critical care settings.
EXPERIENCIA Y OBJETIVOS: El objetivo de este estudio fue validar la versión portuguesa de la escala Nursing Delirium Screening Scale (Nu-DESC) para uso en ambientes de cuidados intensivos. MÉTODOS: Simultánea e independientemente, evaluamos el aparecimiento de delirio en todos los pacientes postoperatorios ingresados en una Unidad de Cuidados Intensivos Quirúgica (UCIQ) a lo largo de un período de un mes, utilizando las versiones portuguesas de Nu-DESC y de la escala Intensive Care Delirium Screening Checklist (ICDSC) dentro de 24 horas a partir del momento del ingreso, tanto por el médico del equipo de investigación, como por el enfermero directamente encargado del paciente. Determinamos la exactitud diagnóstica de Nu-DESC utilizando análisis de sensibilidad, especificidad y de la curva ROC. Evaluamos la confiabilidad entre enfermeros/médico del equipo de investigación para Nu-DESC por el coeficiente de correlación intraclase (CCI). Evaluamos la concordancia y la confiabilidad entre Nu-DESC y ICDSC por porcentajes globales y específicos de concordancia, y por estadística kappa. RESULTADOS: Basándonos en la escala ICDSC, diagnosticamos delirio en 12 de los 78 pacientes. Para la puntuación Nu-DESC total, consideramos como alta la confiabilidad entre enfermeros/médico del equipo. En cuanto al diagnóstico, consideramos perfecta la concordancia entre enfermeros y médico del equipo. El porcentaje de concordancia global entre Nu-DESC y ICDSC para el diagnóstico de delirio fue de 0,88, y kappa varió de 0,79 a 0,93. La sensibilidad de la escala Nu-DESC fue de un 100%, y el de especificidad de un 86%. CONCLUSIONES: La versión portuguesa de la escala Nu-DESC parece ser un instrumento de evaluación y monitoreo exacto y confiable para el diagnóstico del delirio en ambientes de cuidados intensivos.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Críticos , Delirio/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Portugal , Estudios Prospectivos , Reproducibilidad de los Resultados , Curva ROCRESUMEN
BACKGROUND AND OBJECTIVES: The aim of this study was to validate the Portuguese version of the Nursing Delirium Screening Scale (Nu-DESC) for use in critical care settings. METHODS: We simultaneously and independently evaluated all postoperative patients admitted to a surgical Intensive Care Unit (SICU) over a 1-month period for delirium, using the Portuguese versions of both the Nu-DESC and the Intensive Care Delirium Screening Checklist (ICDSC) within 24 hours of admission by both the research staff physician and one bedside nurse. We determined the diagnostic accuracy of the Nu-DESC using sensitivity, specificity and ROC curve analyses. We assessed reliability between nurses and the research staff physician for Nu-DESC by intraclass correlation coefficient (ICC). We assessed agreement and reliability between Nu-DESC and ICDSC by overall and specific proportions of agreement and by kappa statistics. RESULTS: Based on the ICDSC, we diagnosed delirium in 12 of the 78 patients. Reliability between nurses and the staff physician for total Nu-DESC score was high. Agreement between nurses and staff physician in the delirium diagnosis was perfect. The proportion of overall agreement between Nu-DESC and ICDSC in the delirium diagnosis was 0.88 and the kappa ranged from 0.79 to 0.93. Nu-DESC Sensitivity was 100 and specificity was 86%. CONCLUSIONS: The Portuguese version of the Nu-DESC appears to be an accurate and reliable assessment and monitoring instrument for delirium in critical care settings.
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Cuidados Críticos , Delirio/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Portugal , Estudios Prospectivos , Curva ROC , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Both in the recovery room as well as in the intensive care unit post-operative delirium is the most common psychiatric disease. The post-operative delirium is stated in literature to occur in 15 % to 50 % of patients, whereby up to 80 % of patients requiring intensive care with artificial respiration develop a delirium. The delirium correlates with the length of hospital stay and leads to a tripple rate of the six-month-mortality. Nu-DESC, developed by Gaudreau et al. is a measuring instrument for the clinical diagnostics of deliriums which is quickly operable, care-based and which can thus be easily integrated in everyday routine. The aim of this study was the translation of Nu-DESC from English as basis for the use in clinical research and routine. MATERIALS AND METHODS: The translation process was conducted in accordance with the internationally acknowledged guidelines of Translation and Cultural Adaptation of Patient Reported Outcomes Measures - Principles of Good Practice (PGP). An interim German version was developed from 3 independently devised translations, a back-translation of which was then conducted by a registered state-approved translator. The back-translation was then presented to the author of the original for evaluation. RESULTS: The back-translation of the German translation was authorised by the author of the original. On the basis of the cognitive debriefing results which were consistently very good to good, the translation process could be finalised and the final German version of Nu-DESC could be passed by the expert team. An evaluation of the German Nu-DESC regarding its practicability showed significant differences between doctors and nursing staff. CONCLUSION: The German version of Nu-DESC provides an instrument for evaluating the delirium in the area of clinical routine and research.
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Delirio/clasificación , Delirio/diagnóstico , Tamizaje Masivo/métodos , Diagnóstico de Enfermería/métodos , Psicometría/métodos , Índice de Severidad de la Enfermedad , Delirio/enfermería , Alemania , Humanos , Internacionalidad , Lenguaje , Guías de Práctica Clínica como Asunto , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Delirium is an important problem in hospitalized cancer patients. The objective of this study was to determine whether exposure to corticosteroids, benzodiazepines, or opioids predicted delirium. METHODS: A prospective cohort study was conducted in an oncology/internal medicine population. Patients were assessed continuously for the presence of delirium until they were discharged by using the Nursing Delirium Screening Scale (Nu-DESC). Follow-up for outcome began after incident delirium. The primary outcome was the presence of a delirium event, which was defined as a Nu-DESC score >1. Strengths of associations of medications with delirium were expressed as odds ratios (ORs) in univariate and multivariate analyses. RESULTS: In total, 114 patients (1823 patient-days) met the inclusion criteria for the study. The mean follow-up from incident delirium was 16 days. The mean number of delirium events by patient was 6 (total number, 667 delirium events). Analysis by day on several occasions revealed significant associations between opioids and delirium. Corticosteroids and benzodiazepines were not associated significantly with an increased risk of delirium on any given day. Analysis by patient using generalized estimating equation (GEE) models showed an increased risk of delirium on any day of follow-up associated with opioid exposure in univariate analysis (OR of 1.70; P<.0001). The association remained significant after adjustment for corticosteroid, benzodiazepine, and antipsychotic exposure using GEE regressions (OR of 1.37; P=.0033). Truncating follow-up at 30 days did not affect the results (OR of 1.38; P<.032). CONCLUSIONS: Exposure to opioids during hospitalization was associated significantly with an increased longitudinal risk of delirium.
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Delirio/inducido químicamente , Hospitalización , Neoplasias/tratamiento farmacológico , Psicotrópicos/efectos adversos , Corticoesteroides/efectos adversos , Analgésicos Opioides/efectos adversos , Benzodiazepinas/efectos adversos , Estudios de Cohortes , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/diagnóstico , Estudios Prospectivos , Medición de RiesgoRESUMEN
PURPOSE: Psychoactive medications are biologically plausible and potentially modifiable risk factors of delirium. To date, however, research findings are inconsistent regarding their association with delirium. The association between exposure to anticholinergics, benzodiazepines, corticosteroids, and opioids and the risk of delirium was studied. PATIENTS AND METHODS: A total of 261 hospitalized cancer patients were followed up with repeated assessments by using the Nursing Delirium Screening Scale for up to 4 weeks for incident delirium. Detailed exposure to psychoactive medications was documented daily. Strengths of association with delirium were expressed as hazard ratios (HRs) in univariate and multivariate analyses by using Cox regression models. All medication variables were coded as time-dependent covariates. Whenever possible, exposure was computed by using cumulative daily doses in equivalents; dichotomous cutoffs were determined. RESULTS: During follow-up (mean, 8.6 days), 43 patients became delirious (16.5%). Delirium was associated with a history of delirium and the presence of hepatic metastases at admission. Analysis of the effect of medications was performed adjusting for these factors. Patients exposed to daily doses of benzodiazepines above 2 mg (HR, 2.04; 95% CI, 1.05 to 3.97), above 15 mg of corticosteroids (HR, 2.67; 95% CI, 1.18 to 6.03), or above 90 mg of opioids (HR, 2.12; 95% CI, 1.09 to 4.13) had increases in the risks for delirium. We did not observe associations between anticholinergics and risk for delirium. CONCLUSION: Exposure to opioids, corticosteroids, and benzodiazepines is independently associated with an increased risk of delirium in hospitalized cancer patients.
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Delirio/inducido químicamente , Delirio/epidemiología , Neoplasias/tratamiento farmacológico , Psicotrópicos/efectos adversos , Adulto , Distribución por Edad , Anciano , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Análisis de Varianza , Estudios de Cohortes , Intervalos de Confianza , Delirio/fisiopatología , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Hospitalización , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Neoplasias/psicología , Probabilidad , Modelos de Riesgos Proporcionales , Psicotrópicos/uso terapéutico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por SexoRESUMEN
Psychoactive medications are often reported as delirium risk factors in hospitalized patients, and delirium induced by medication is potentially avoidable. The authors critically reviewed the evidence for a role of medications in delirium etiology. Only a few positive associations were noted. Use of psychoactive medications, considered together as a single variable, and use of opioids increased the risk of delirium. Data were scarce and sometimes conflicting, and methodological limitations were often present. The suspected association between psychoactive drugs and delirium cannot be unambiguously confirmed with current epidemiological evidence. The interpretation of these results must take into account the limitations of published studies, which should be addressed in future research.
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Delirio/inducido químicamente , Hospitalización , Trastornos Mentales/tratamiento farmacológico , Psicotrópicos/efectos adversos , Delirio/epidemiología , Humanos , Trastornos Mentales/rehabilitaciónRESUMEN
Early symptoms of delirium often go unnoticed. The Nursing Delirium Screening Scale (Nu-DESC) is a recently developed short, accurate and sensitive 24-h screening instrument. The Nu-DESC is more sensitive than the instrument from which it was derived, the Confusion Rating Scale (CRS). This study examined the impact on delirium detection of using the Nu-DESC over the CRS in 134 consecutive oncology patients. Expected false-negative rate (FNR) reductions at different delirium prevalence rates when using the Nu-DESC compared to the CRS and the number needed to screen (NNS) by the Nu-DESC were calculated. Kaplan-Meier survival analyses were used to study Nu-DESC-CRS divergences in delirium status and length of delirium-free survival. Ninety-nine patients were negative for delirium according to both tests. Of the remaining 35 patients, 16 had identical Nu-DESC-CRS delirium status and delirium-free survival, whereas 19 were detected later by the CRS (mean, 4.8 days). Among the 19 patients, 6 were still CRS negative upon hospital discharge. Integrating a continuous and sensitive delirium assessment instrument into usual care can facilitate its recognition, since more cases of delirium are diagnosed and patients are detected earlier.
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Delirio/diagnóstico , Tamizaje Masivo/instrumentación , Adulto , Diagnóstico Precoz , Femenino , Humanos , Masculino , Oncología Médica , Persona de Mediana Edad , Quebec , Sensibilidad y EspecificidadRESUMEN
Because no rigorously validated, simple yet accurate continuous delirium assessment instrument exists, we developed the Nursing Delirium Screening Scale (Nu-DESC). The Nu-DESC is an observational five-item scale that can be completed quickly. To test the validity of the Nu-DESC, 146 consecutive hospitalized patients from a prospective cohort study were continuously assessed for delirium symptoms by bedside nurses using the Nu-DESC. Psychometric properties of Nu-DESC screening were established using 59 blinded Confusion Assessment Method (CAM) ratings made by research nurses and psychiatrists. DSM-IV criteria and the Memorial Delirium Assessment Scale (MDAS) were rated along with CAM assessments. Analysis of these data showed that the Nu-DESC is psychometrically valid and has a sensitivity and specificity of 85.7% and 86.8%, respectively. These values are comparable to those of the MDAS, a longer instrument. Nu-DESC and DSM-IV sensitivities were similar. The Nu-DESC appears to be well-suited for widespread clinical use in busy oncology inpatient settings and shows promise as a research instrument.
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Delirio/clasificación , Delirio/diagnóstico , Tamizaje Masivo/métodos , Diagnóstico de Enfermería/métodos , Psicometría/métodos , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Delirio/enfermería , Femenino , Hospitalización , Humanos , Masculino , Escala del Estado Mental , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Método Simple CiegoRESUMEN
Delirium is thought to be a temporary psychiatric disorder resulting from a reduced central cholinergic transmission, combined with an increased dopaminergic transmission. The cholinergic and the dopaminergic systems interact not only with each other but with glutamatergic and gamma-amino-butyric acid (GABA) pathways. Besides the cerebral cortex, critical anatomical substrates of psychosis pathophysiology would comprise the striatum, the substantia nigra/ventral tegmental area, and the thalamus. The thalamus acts as a filter, allowing only the relevant information to travel to the cortex. Drugs of abuse (e.g. PCP, Ecstasy), as well as psychoactive medications frequently prescribed to hospitalized patients (e.g. benzodiazepines, opioids) could compromise the thalamic gating function, leading to sensory overload and hyperarousal. We propose that drug-induced delirium would result from the transient thalamic dysfunction caused by exposure to medications that interfere with central glutamatergic, GABAergic, dopaminergic and cholinergic pathways at critical sites of action. This model provides directions for future studies in neurophysiology, in vivo brain imaging, and psychopharmacology investigating delirium neuropathophysiology.