Effect of delirium motoric subtypes on administrative documentation of delirium in the surgical intensive care unit

Lan N. Bui, Vy P. Pham, Beverly A. Shirkey, Joshua T. Swan

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

This study compares the proportions of surgical intensive care unit (ICU) patients with delirium detected using the Confusion Assessment Method for the ICU (CAM-ICU) who received administrative documentation for delirium using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, stratified by delirium motoric subtypes. This retrospective cohort study was conducted at a surgical ICU from 06/2012 to 05/2013. Delirium was assessed twice daily and was defined as having ≥1 positive CAM-ICU rating. Delirious patients were categorized into hyperactive/mixed and hypoactive subtypes using corresponding Richmond Agitation Sedation Scales. Administrative documentation of delirium was defined as having ≥1 of 32 unique ICD-9-CM codes. Proportions were compared using Pearson’s Chi-square test. Of included patients, 40 % (423/1055) were diagnosed with delirium, and 17 % (183/1055) had an ICD-9-CM code for delirium. The sensitivity and specificity of ICD-9-CM codes for delirium were 36 and 95 %. ICD-9-CM codes for delirium were available for 42 % (95 % CI 35–48 %; 105/253) of patients with hyperactive/mixed delirium and 27 % (95 % CI 20–34 %; 46/170) of patients with hypoactive delirium (relative risk = 1.5; 95 % CI 1.2–2.0; p = 0.002). ICD-9-CM codes yielded a low sensitivity for identifying patients with CAM-ICU positive delirium and were more likely to identify hyperactive/mixed delirium compared with hypoactive delirium.

Original languageEnglish (US)
Pages (from-to)631-640
Number of pages10
JournalJournal of Clinical Monitoring and Computing
Volume31
Issue number3
DOIs
StatePublished - Jun 1 2017

Keywords

  • CAM-ICU
  • Delirium
  • Delirium motoric subtypes
  • ICD-9-CM
  • Surgical ICU

ASJC Scopus subject areas

  • Health Informatics
  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine

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