Comparison of the confusion assessment method for intensive care units seven-item scale for intensive care units and the intensive care delirium screening checklist in predicting adverse outcomes for patients undergoing cardiovascular surgery.

AIMS: This study aimed to evaluate the ability of the Confusion Assessment Method for Intensive Care Units 7-Item Scale (CAM-ICU-7) compared with the Intensive Care Delirium Screening Checklist (ICDSC) in assessing post-operative delirium (POD) and predicting adverse outcomes.

METHODS AND RESULTS: Patients >20 years undergoing elective cardiovascular surgery were recruited in this prospective cohort study in Taiwan. Emergence delirium was evaluated following discontinuing sedation, followed by POD assessments, conducted twice-daily until the patient was transferred to ward. All datasets were obtained from 84 patients and encompassed 833 assessments. The POD incidence was 48% and 45%, as detected using the ICDSC and CAM-ICU-7, respectively, whereas the incidence of concurrent POD and subsyndromal delirium (SSD) was 35% and 21%, respectively. It revealed high agreement for POD in the two tools (kappa = 0.84, P < 0.001) but moderate-to-poor for SSD (kappa = 0.21, P < 0.001). The ICDSC detected SSD better than the CAM-ICU-7. POD detected using both tools and concurrent POD and SSD detected using ICDSC predicted the intensive care unit (ICU) stay duration and the number of adverse events (P < 0.001). Concurrent POD and SSD detected using ICDSC predicted the hospital length of stay (P < 0.001), whereas POD detected using both tools predicted adverse event occurrence.

CONCLUSION: POD and concurrent POD and SSD are associated with adverse outcomes. The CAM-ICU-7 and ICDSC can both diagnose POD. The ICDSC outperforms CAM-ICU-7 in detecting SSD and predicting adverse outcomes, suggesting that it is a better tool for cardiovascular-surgical patients.