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What's Missing In ICU Delirium Assessment? The importance Of CAM-unable-to-assess
*Foula Kontonicolas
Hartford Hospital, Hartford, CT

Objective : Unplanned extubation (UE) is a safety metric and contributes to ICU morbidity. Risk factors for UE include sedation level, restraint use and severity of illness. Delirium, an important contributor to patient outcomes, is assessed by CAM-ICU as positive or negative. More frequently we have identified that some ICU patients are unable to be assessed by CAM (CAM-UTA); however, it is unclear as to the significance of this category. This study explored the relationship of CAM-UTA and other risk factors for UE and their impact on patient outcomes. The purpose of this study was to determine the impact of CAM-UTA on UE.
Design: Retrospective case matched comparison study
Setting: Surgical ICUs in a Level 1 Trauma center
Patients: The medical records of patients who had UE from January 2009 to December 2013 were reviewed. Patients with planned extubation (PE) case matched for age, gender and ventilator length of stay, served as controls. 182 patients were included.
Main Outcome Measures: These included ICU LOS, hospital LOS, re-intubation rates, discharge disposition and mortality.
Results: Risk factors for UE included CAM-UTA and restraint use (P<0.01). UE vs. PE showed no differences in demographics, TBI, ICU LOS, or SOFA. Post-extubation CAM-UTA patients vs. CAM (-) were more likely to be reintubated within 48 hours, had higher mortality, longer ICU LOS (P<0.01) and less discharge home (P<0.05) compared to CAM (-) patients.
Conclusions: CAM-UTA is an important quality characteristic to follow in the ICU as it was associated with worse outcomes and the preventable complication of UE. It is unclear why patients are assessed as CAM-UTA, however, understanding this important metric may impact patient safety and quality of care.

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Back to 2016 Annual Meeting Posters