Investigation of Frequently Used Measurement Tools For Evaluation of Delirium

Abstract

Delirium is defined as an acute onset, fluctuations mental state with a reversible syndrome. It has been estimated that 10-30% of patients admitted to the hospital develop delirium. Delirium is also frequently seen elderly, postoperative and intensive care patient populations. Early diagnosis of delirium gains importance to prevent prolonged hospital stay, increased morbidity, hospital cost and mortality resulting from delirium and to control delirium symptoms early. This situation raises the issue of making use of tools specially designed for the diagnosis of delirium or to help diagnose them, knowing the purpose and function of these tools. The first step in preventing, detecting, identifying and implementing effective strategies is to monitor patients with appropriate assessment tools. Most healthcare professionals can ignore or have difficulty managing delirium. In this review article, it is aimed to summarize the purpose, function and suitability of commonly used measurement instruments in delirium evaluation and to guide health professionals and to create awareness by eliminating the deficiency in the literature.

Keywords

• Delirium.,Agitation,Scale

Deliryumun Değerlendirilmesinde Sık Kullanılan Ölçüm Araçlarının İncelenmesi

Abstract

Deliryum; akut başlangıçlı, mental durumda dalgalanmalar gösteren ve geri dönüşü olan bir sendromdur. Hastaneye başvuran hastaların %10-30'unda deliryum geliştiği tahmin edilmektedir. Deliryum; yaşlı, operasyon sonrası ve yoğun bakım hasta popülasyonların da sıklıkla görülmektedir. Deliryum sonucunda gelişen, uzamış hastane yatış süresi, artmış morbidite, hastane maliyeti ve mortalitenin önüne geçilmesi için ve deliryum semptomlarının erken dönem kontrol altına alınabilmesi için deliryumun erken tanısı önem kazanmaktadır. Bu durum deliryuma özel tasarlanmış veya tanılanmasına yardımcı araçlardan yararlanmak, bu araçların amaç ve işlevini bilmek konusunu gündeme getirmektedir. Deliryumu önlemek, tespit etmek, etkili stratejiler belirlemek ve uygulamak adına ilk adım, uygun değerlendirme aracı ile hastaları izlemektir. Sağlık profesyonellerinin çoğu deliryumu göz ardı edebilmekte veya yönetmede zorlanabilmektedir. Bu derleme makalesinde deliryum değerlendirilmesinde sık kullanılan ölçme araçlarının amaç, işlevi ve uygunluğu özetlenerek sağlık profesyonellerine yol göstermesi ve literatürde konu ile ilgili eksikliğin giderilerek farkındalık oluşturması amaçlanmaktadır.

Keywords

• Deliryum,tanılama,ölçek

References

1. 1. Mattoo SK, Grover S, Gupta N. Delirium in general practice. Indian J Med Res. 2010;131:387-98.
2. 2. Grover S, Shah R. Delirium-related distress in caregivers: a study from a tertiary care centre in India. Perspect Psychiatr Care. 2013;49(1):21-29.
3. 3. Grover S, Shah R. Distress due to delirium experience. Gen Hosp Psychiatry. 2011;33(6):637-639.
4. 4. Grover S, Kate N. Assessment scales for delirium: A review. World J Psychiatry. 2012;2(4):58-70.
5. 5. Tieges Z, Evans JJ, Neufeld KJ, MacLullich AMJ. The neuropsychology of delirium: advancing the science of delirium assessment. Int J Geriatr Psychiatry. 2018;33(11):1501-1511.
6. 6. Martins S, Fernandes L. Delirium in elderly people: a review. Front Neurol. 2012;3:101.
7. 7. Johansson YA, Bergh I, Ericsson I, Sarenmalm EK. Delirium in older hospitalized patients-signs and actions: a retrospective patient record review. BMC Geriatr. 2018;18(1):43.
8. 8. Cerejeira J, Mukaetova-Ladinska EB. A clinical update on delirium: from early recognition to effective management. Nurs Res Pract. 2011;2011:875196.

9. 9. Coster WJ. Making the best match: selecting outcome measures for clinical trials and outcome studies. Am J Occup Ther. 2013;67(2):162-170.
10. 10. Angel C, Brooks K, Fourie J. Standardizing Management of Adults with Delirium Hospitalized on Medical-Surgical Units. Perm J. 2016;20(4):16-002.
11. 11. Mariz J, Costa Castanho T, Teixeira J, Sousa N, Correia Santos N. Delirium Diagnostic and Screening Instruments in the Emergency Department: An Up-to-Date Systematic Review. Geriatrics (Basel). 2016;1(3):22.
12. 12. Sessler CN, Gosnell MS, Grap MJ et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338-1344.
13. 13. Han JH, Vasilevskis EE, Schnelle JF et al. The Diagnostic Performance of the Richmond Agitation Sedation Scale for Detecting Delirium in Older Emergency Department Patients. Acad Emerg Med. 2015;22(7):878-882.
14. 14. Nagaraj SB, McClain LM, Zhou DW et al. Automatic Classification of Sedation Levels in ICU Patients Using Heart Rate Variability. Crit Care Med. 2016;44(9):e782-e789.
15. 15. Peterson JF, Pun BT, Dittus RS et al. Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc. 2006;54(3):479-484.
16. 16. Grover S, Avasthi A. Clinical Practice Guidelines for Management of Delirium in Elderly. Indian J Psychiatry. 2018;60(Suppl 3):S329-S340.
17. 17. Arumugam S, El-Menyar A, Al-Hassani A et al. Delirium in the Intensive Care Unit. J Emerg Trauma Shock. 2017;10(1):37-46.
18. 18. Sılay F, Akyol A. Yoğun Bakım Ünitelerinde Sedasyon-Ajitasyon ve Ağrı Değerlendirmesinde Kullanılan İki Ölçüm Aracının Türkçe’ye Uyarlanması: Geçerlik ve Güvenirlik Çalışması. Yoğun Bakım Hemşireliği Dergisi. 2018;22(2):50-65.
19. 19. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2(5920):656-659.
20. 20. Esen H, Öntürk ZK, Badır A, Aslan FE. Entübe ve Sedatize Yoğun Bakım Hastalarının Pozisyon Verme ve Aspirasyon Sırasındaki Ağrı Davranışları. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi. 2010;1(2):89-93.
21. 21. Kaya P, Erden S. Cross-cultural adaptation, validity and reliability of the Turkish version of Revised Nonverbal Pain Scale. Agri 2019;31(1):15-22.
22. 22. Mendes CL, Vasconcelos LCS, Tavares JS et al. Ramsay and Richmond's scores are equivalent to assessment sedation level on critical patients. Revista Brasileira de Terapia Intensiva. 2008;20(4):344-348.
23. 23. Devlin JW, Boleski G, Mlynarek M et al. Motor Activity Assessment Scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. Crit Care Med. 1999;27(7):1271-1275.
24. 24. Korhan EA, Bor C, Uyar M. Yetişkin Yoğun Bakım Hastasında Ağrının Değerlendirilmesi. Yoğun Bakım Hemşireliği Dergisi 2012;16(2):57-65.
25. 25. Riker RR, Picard JT, Fraser GL . Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients . Crit Care Med. 1999; 27(7):1325-1329.
26. 26. Sılay F, Akyol A. Yoğun Bakım Ünitelerinde Sedasyon Kontrolünde Hemşirenin Rolü. Yoğun Bakım Hemşireliği Dergisi. 2017;21(1):28-35.
27. 27. Khan BA, Guzman O, Campbell NL et al. Comparison and agreement between the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale in evaluating patients' eligibility for delirium assessment in the ICU. Chest. 2012;142(1):48-54.
28. 28. Neelon VJ, Champagne MT, Carlson JR, Funk SG. The NEECHAM Confusion Scale: construction, validation, and clinical testing. Nurs Res. 1996;45(6):324-330.
29. 29. Gemert van LA, Schuurmans MJ. The Neecham Confusion Scale and the Delirium Observation Screening Scale: capacity to discriminate and ease of use in clinical practice. BMC Nurs. 2007;6:3.
30. 30. Sörensen Duppils G, Johansson I. Predictive value and validation of the NEECHAM Confusion Scale using DSM-IV criteria for delirium as gold standard. Int J Older People Nurs. 2011;6(2):133-142.
31. 31. Elibol N, Karaöz S. NEECHAM Konfüzyon Ölçeği'nin Türkçe'ye Uyarlanması. Anadolu Psikiyatri Derg 2019; 20(Ek sayı.1):48-54.
32. 32. Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage. 2005;29(4):368-375.
33. 33. De J, Wand AP. Delirium Screening: A Systematic Review of Delirium Screening Tools in Hospitalized Patients. Gerontologist. 2015;55(6):1079-1099.
34. 34. Çınar F, Eti Aslan F. Evaluation of Postoperative Delirium: Validity and Reliability of the Nursing Delirium Screening Scale in the Turkish Language. Dement Geriatr Cogn Disord Extra 2019;9:362-373.
35. 35. Schuurmans MJ, Donders RT, Shortridge-Baggett LM, Duursma SA. Delirium case finding: pilot testing of a new screening scale for nurses. J Am Geriatr Soc. 2002;50:S3.
36. 36. Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The Delirium Observation Screening Scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003;17(1):31-50.
37. 37. Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27(5):859-864.
38. 38. Carvalho JP, de Almeida AR, Gusmao-Flores D. Delirium rating scales in critically ill patients: a systematic literature review. Rev Bras Ter Intensiva. 2013;25(2):148-154.
39. 39. Bölüktaş RP. Yoğun Bakım Ünitelerindeki Yaşlı Hastalarda Deliryumun Değerlendirilmesi, Önlenmesi ve Yönetimine İlişkin Stratejiler. Yoğun Bakım Hemşireliği Dergisi 2015;19(2):68-79.
40. 40. Kose G, Bolu A, Ozdemir L, Acikel C, Hatipolu S. Reliability and validity of the intensive care delirium screening checklist in Turkish. Int J Nurs Knowl 2016;27(2): 119-124.
41. 41. Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004;100(5):1138-1145.
42. 42. Mason KP. Paediatric emergence delirium: a comprehensive review and interpretation of the literature. Br J Anaesth. 2017;118(3):335-343.
43. 43. Lee CA. Paediatric Emergence Delirium: An Approach to Diagnosis and Management in the Postanaesthesia Care Unit. J Perioper Crit Intensive Care Nurs. 2017;3(2):1-3.
44. 44. Uğur G, Bombacı E, Çevik B. Evaluation of Factors Affecting Emergence Agitation in Pediatric Anesthesia Practice. SCIE 2018;29(1):36-44.
45. 45. Trzepacz PT, Baker RW, Greenhouse J. A symptom rating scale for delirium. Psychiatry Res. 1988;23(1):89-97.
46. 46. Trzepacz PT, Mittal D, Torres R et al. Validation of the Delirium Rating Scale-Revised-98: comparison with the delirium rating scale and the cognitive test for delirium. J Neuropsychiatry Clin Neurosci 2001;13:229-242.
47. 47. Cinar MA, Ozmenler KN, Ozsahin A, Trzepacz PT. Reliability and Validity of the Turkish Translation of the Delirium Rating ScaleRevised-98. Düşünen Adam The Journal of Psychiatry and Neurological Sciences 2014;27(3):186-193.
48. 48. Turkel SB, Braslow K, Tavaré CJ, Trzepacz PT. The delirium rating scale in children and adolescents. Psychosomatics 2003;44:126-129.
49. 49. Breitbart W, Rosenfeld B, Roth A et al. The Memorial Delirium Assessment Scale. J Pain Symptom Manage. 1997;13(3):128-137.
50. 50. Mercadante S, Adile C, Ferrera P, Cortegiani A, Casuccio A. Delirium assessed by Memorial Delirium Assessment Scale in advanced cancer patients admitted to an acute palliative/supportive care unit. Curr Med Res Opin. 2017;33(7):1303-1308.
51. 51. Inouye SK, van Dyck CH, Alessi CA et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113(12):941-948.
52. 52. Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The Confusion Assessment Method: a systematic review of current usage. J Am Geriatr Soc. 2008;56(5):823-830.
53. 53. Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. Confusion assessment method in the diagnostics of delirium among aged hospital patients: would it serve better in screening than as a diagnostic instrument? Int J Geriatr Psychiatry. 2002;17(12):1112-1119.
54. 54. Ely EW, Inouye SK, Bernard GR et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703-2710.
55. 55. Ely EW, Margolin R, Francis J et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29(7):1370-1379.
56. 56. Han JH, Wilson A, Graves AJ et al. Validation of the Confusion Assessment Method for the Intensive Care Unit in older emergency department patients. Acad Emerg Med. 2014;21(2):180–187.
57. 57. Orman ES, Perkins A, Ghabril M et al. The confusion assessment method for the intensive care unit in patients with cirrhosis. Metab Brain Dis. 2015;30(4):1063-1071.
58. 58. Fan Y, Guo Y, Li Q, Zhu X. A review: Nursing of intensive care unit delirium. J Neurosci Nurs. 2012;44(6):307-316.
59. 59. Smith HA, Boyd J, Fuchs DC et al. Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit. Crit Care Med. 2011;39(1):150-157.
60. 60. de Grahl C, Luetz A, Gratopp A et al. The paediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU): translation and cognitive debriefing for the German-speaking area. Ger Med Sci. 2012;10:Doc07.
61. 61. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198.
62. 62. Ringdal GI, Ringdal K, Juliebø V et al. Using the Mini-Mental State Examination to screen for delirium in elderly patients with hip fracture. Dement Geriatr Cogn Disord. 2011;32(6):394-400.
63. 63. Mitchell AJ, Shukla D, Ajumal HA, Stubbs B, Tahir TA. The Mini-Mental State Examination as a diagnostic and screening test for delirium: systematic review and meta-analysis. Gen Hosp Psychiatry. 2014;36(6):627-633.
64. 64. Güngen C, Ertan T, Eker E, Yaşar R, Engin F. Standardize Mini Mental Test’in Türk Toplumunda Hafif Demans Tan›s›nda Geçerlik ve Güvenilirliği. Türk Psikiyatri Dergisi 2002;13(4):273-281.
65. 65. Zama IN, Maynard WK, Davis MP. Clocking delirium: the value of the Clock Drawing Test with case illustrations. Am J Hosp Palliat Care. 2008;25(5):385-388.
66. 66. Adamis D, Meagher D, O'Neill D, McCarthy G. The utility of the clock drawing test in detection of delirium in elderly hospitalised patients. Aging Ment Health. 2016;20(9):981-986.