Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjan.2012.09.002
Brazilian Journal of Anesthesiology
Scientific Article

Avaliação do delírio em pacientes pós-operatórios: validação da versão portuguesa da Nursing Delirium Screening Scale na terapia intensiva

Delirium assessment in postoperative patients: validation of the portuguese version of the Nursing Delirium Screening Scale in critical care

Fernando Abelha; Dalila Veiga; Maria Norton; Cristina Santos; Jean-David Gaudreau

http://dx.doi.org/10.1016/j.bjan.2012.09.002 Braz J Anesthesiol, vol.63, n6, p.450-455, 2013
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Resumo

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.

Palavras-chave

Delírio, Terapia pós-operatória, Terapia intensiva

Abstract

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.

Keywords

Delirium, Postoperative care, Critical care

References

Ely EW, Shintani A, Truman B. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Jama. 2004;291:1753-62.

Leslie DL, Zhang Y, Holford TR. Premature death associated with delirium at 1-year follow-up. Arch Intern Med. 2005;165:1657-62.

Olin K, Eriksdotter-Jönhagen M, Jansson A. Postoperative delirium in elderly patients after major abdominal surgery. Br J Surg. 2005;92:1559-64.

Thomason JW, Shintani A, Peterson JF. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care. 2005;9:R375-81.

Zakriya K, Sieber FE, Christmas C. Brief postoperative delirium in hip fracture patients affects functional outcome at three months. Anesth Analg. 2004;98:1798-802.

Aakerlund LP, Rosenberg J. Postoperative delirium: treatment with supplementary oxygen. Br J Anaesth. 1994;72:286-90.

Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth. 2009;103(^s1):i41-6.

Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Crit Care. 2008;12(^s3).

Quimet S, Kavanagh B, Gottfried SB. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med. 2007;33:66-73.

Bergeron N, Dubois MJ, Dumont M. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27:859-64.

Ely EW, Gautam S, Margolin R. The impact of delirium in the intensive care unit on hospital length of stay. Intens Care Med. 2001;27:1892-900.

Ely EW, Inouye SK, Bernard GR. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). Jama. 2001;286:2703-10.

Gaudreau JD, Gagnon P, Harel F. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage. 2005;29:368-75.

Luetz A, Heymann A, Radtke FM. Different assessment tools for intensive care unit delirium: which score to use?. Crit Care Med. 2010;38:409-18.

Lutz A, Radtke FM, Franck M. The Nursing Delirium Screening Scale (NU-DESC). Anasthesiol Intensivmed Notfallmed Schmerzther. 2008;43:98-102.

Johnson J. Identifying and recognizing delirium. Dement Geriatr Cogn Disord. 1999;10:353-8.

Milisen K, Foreman MD, Abraham IL. A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients. J Am Geriatr Soc. 2001;49:523-32.

Lundstrom M, Edlund A, Karlsson S. A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc. 2005;53:622-8.

Jacobi J, Fraser GL, Coursin DB. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002;30:119-41.

Diagnostic and statistical manual mental disorders IV (DSM IV). 1994.

Radtke FM, Franck M, Schneider M. Comparison of three scores to screen for delirium in the recovery room. Br J Anaesth. 2008;101:338-43.

Radtke FM, Franck M, MacGuill M. Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium. Eur J Anaesthesiol. 2010;27:411-6.

Wild D, Grove A, Martin M. 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. 2005;8:94-104.

Cronbach LJ. Coefficient Alpha and the internal structure of tests. Psychometrika. 1951;16:297-334.

Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420-8.

Leung JM, Leung VW, Leung CM. Clinical utility and validation of two instruments (the Confusion Assessment Method Algorithm and the Chinese version of Nursing Delirium Screening Scale) to detect delirium in geriatric inpatients. Gen Hosp Psychiatry. 2008;30:171-6.

Radtke FM, Franck M, Schust S. A comparison of three scores to screen for delirium on the surgical ward. World J Surg. 2010;34:487-94.

Devlin JW, Marquis F, Riker RR. Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside. Crit Care. 2008;12:R19.

Pun BT, Gordon SM, Peterson JF. Large-scale implementation of sedation and delirium monitoring in the intensive care unit: a report from two medical centers. Crit Care Med. 2005;33:1199-205.

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