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Diagnostic Performance of Delirium Assessment Tools in Critically Ill Patients: A Systematic Review and Meta‐Analysis

Journal Article


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Abstract


  • Background

    Critical care nurses are in the best position to detect and monitor delirium in critically ill patients. Therefore, an optimum delirium assessment tool with strong evidence should be identified with critical care nurses to perform in the daily assessment.

    Aim

    To evaluate and compare the diagnostic performance of delirium assessment tools in diagnosing delirium in critically ill patients.

    Methods

    We searched five electronic databases including the Cochrane Library, PubMed, Embase, CINAHL, and a Chinese database for eligible diagnostic studies published in English or Mandarin up to December 2018. This diagnostic test accuracy meta‐analysis was limited to studies in intensive care unit (ICU) settings, using the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a standard reference to test the accuracy of delirium assessment tools. Eligible studies were critically appraised by two investigators independently. The summary of evidence was conducted for pooling and comparing diagnostic accuracy by a bivariate random effects meta‐analysis model. The pooled sensitivities and specificities, summary receiver operating characteristic curve (sROC), the area under the curve (AUC), and diagnostic odds ratio (DOR) were calculated and plotted. The possibility of publication bias was assessed by Deeks’ funnel plot.

    Data Synthesis

    We identified and evaluated 23 and 8 articles focused on CAM‐ICU and ICDSC, respectively. The summary sensitivities of 0.85 and 0.87, and summary specificities of 0.95 and 0.91 were found for CAM‐ICU and ICDSC, respectively. The AUC of the CAM‐ICU was 0.96 (95% CI, 0.94–0.98), with DOR at 99 (95% CI, 55–177). The AUC of the ICDSC was 0.95 (95% CI, 0.92–0.96), and the DOR was 65 (95% CI, 27–153).

    Linking Evidence to Action

    CAM‐ICU demonstrated higher diagnostic test accuracy and is recommended as the optimal delirium assessment tool. However, the results should be interpreted with caution due to the between‐study heterogeneity of this diagnostic test accuracy meta‐analysis.

Publication Date


  • 2020

Citation


  • Ho, M., Montgomery, A., Traynor, V., Chang, C., Kuo, K. N., Chang, H. & Chen, K. (2020). Diagnostic Performance of Delirium Assessment Tools in Critically Ill Patients: A Systematic Review and Meta‐Analysis. Worldviews on Evidence-Based Nursing, 17 (4), 301-310.

Scopus Eid


  • 2-s2.0-85089311599

Ro Full-text Url


  • https://ro.uow.edu.au/cgi/viewcontent.cgi?article=2588&context=smhpapers1

Ro Metadata Url


  • http://ro.uow.edu.au/smhpapers1/1554

Has Global Citation Frequency


Number Of Pages


  • 9

Start Page


  • 301

End Page


  • 310

Volume


  • 17

Issue


  • 4

Place Of Publication


  • United States

Abstract


  • Background

    Critical care nurses are in the best position to detect and monitor delirium in critically ill patients. Therefore, an optimum delirium assessment tool with strong evidence should be identified with critical care nurses to perform in the daily assessment.

    Aim

    To evaluate and compare the diagnostic performance of delirium assessment tools in diagnosing delirium in critically ill patients.

    Methods

    We searched five electronic databases including the Cochrane Library, PubMed, Embase, CINAHL, and a Chinese database for eligible diagnostic studies published in English or Mandarin up to December 2018. This diagnostic test accuracy meta‐analysis was limited to studies in intensive care unit (ICU) settings, using the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a standard reference to test the accuracy of delirium assessment tools. Eligible studies were critically appraised by two investigators independently. The summary of evidence was conducted for pooling and comparing diagnostic accuracy by a bivariate random effects meta‐analysis model. The pooled sensitivities and specificities, summary receiver operating characteristic curve (sROC), the area under the curve (AUC), and diagnostic odds ratio (DOR) were calculated and plotted. The possibility of publication bias was assessed by Deeks’ funnel plot.

    Data Synthesis

    We identified and evaluated 23 and 8 articles focused on CAM‐ICU and ICDSC, respectively. The summary sensitivities of 0.85 and 0.87, and summary specificities of 0.95 and 0.91 were found for CAM‐ICU and ICDSC, respectively. The AUC of the CAM‐ICU was 0.96 (95% CI, 0.94–0.98), with DOR at 99 (95% CI, 55–177). The AUC of the ICDSC was 0.95 (95% CI, 0.92–0.96), and the DOR was 65 (95% CI, 27–153).

    Linking Evidence to Action

    CAM‐ICU demonstrated higher diagnostic test accuracy and is recommended as the optimal delirium assessment tool. However, the results should be interpreted with caution due to the between‐study heterogeneity of this diagnostic test accuracy meta‐analysis.

Publication Date


  • 2020

Citation


  • Ho, M., Montgomery, A., Traynor, V., Chang, C., Kuo, K. N., Chang, H. & Chen, K. (2020). Diagnostic Performance of Delirium Assessment Tools in Critically Ill Patients: A Systematic Review and Meta‐Analysis. Worldviews on Evidence-Based Nursing, 17 (4), 301-310.

Scopus Eid


  • 2-s2.0-85089311599

Ro Full-text Url


  • https://ro.uow.edu.au/cgi/viewcontent.cgi?article=2588&context=smhpapers1

Ro Metadata Url


  • http://ro.uow.edu.au/smhpapers1/1554

Has Global Citation Frequency


Number Of Pages


  • 9

Start Page


  • 301

End Page


  • 310

Volume


  • 17

Issue


  • 4

Place Of Publication


  • United States