Reporting of Outcomes and Outcome Measures in Studies of Interventions to Prevent and/or Treat Delirium in the Critically Ill
- 20 February 2020
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 48 (4), e316-e324
- https://doi.org/10.1097/ccm.0000000000004238
Abstract
Objectives: To inform development of a core outcome set, we evaluated the scope and variability of outcomes, definitions, measures, and measurement time-points in published clinical trials of pharmacologic or nonpharmacologic interventions, including quality improvement projects, to prevent and/or treat delirium in the critically ill. Data Sources: We searched electronic databases, systematic review repositories, and trial registries (1980 to March 2019). Study Selection and Data Extraction: We included randomized, quasi-randomized, and nonrandomized intervention studies of pharmacologic and nonpharmacologic interventions. We extracted data on study characteristics, verbatim descriptions of study outcomes, and measurement characteristics. We assessed quality of outcome reporting using the Management of Otitis Media with Effusion in Children with Cleft Palate study scoring system; risk of bias and study quality using the Cochrane tool and Scottish Intercollegiate Guidelines Network checklists. We categorized reported outcomes using Core Outcome Measures in Effectiveness Trials taxonomy. Data Synthesis: From 195 studies (1/195 pediatric) recruiting 74,632 participants and reporting a mean (SD) of 10 (6.2) outcome domains, we identified 12 delirium-specific outcome domains. Delirium incidence (147, 75% of studies), duration (67, 34%), and antipsychotic use (42, 22%) were most commonly reported. We identified a further 94 non–delirium-specific outcome domains within 19 Core Outcome Measures in Effectiveness Trials taxonomy categories. For both delirium-specific and nonspecific outcome domains, we found multiple outcomes in domains due to differing descriptions and time-points. The Confusion Assessment Method-ICU with Richmond Agitation-Sedation Scale to assess sedation was the most common measure used to ascertain delirium (51, 35%). Measurement generally began at randomization or ICU admission, and lasted from 1 to 30 days, ICU/hospital discharge. Frequency of measurement was highly variable with daily measurement and greater than daily measurement reported for 36% and 37% of studies, respectively. Conclusions: We identified substantial heterogeneity and multiplicity of outcome selection and measurement in published studies. These data will inform the consensus building stage of a core outcome set to inform delirium research in the critically ill.This publication has 37 references indexed in Scilit:
- MOMENT – Management of Otitis Media with Effusion in Cleft Palate: protocol for a systematic review of the literature and identification of a core outcome set using a Delphi surveyTrials, 2013
- Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care UnitCritical Care Medicine, 2013
- Preventing Delirium in the Intensive Care UnitCritical Care Clinics, 2013
- Among patients admitted to ICU, delirium is most common in those with neurological diagnoses, and is associated with adverse health outcomesEvidence-Based Nursing, 2012
- Delirium in Critically Ill PatientsDrugs, 2012
- Factors associated with persistent delirium after intensive care unit admission in an older medical patient populationJournal of Critical Care, 2010
- Liberation and animation for ventilated ICU patients: the ABCDE bundle for the back-end of critical careCritical Care, 2010
- OMERACT: An international initiative to improve outcome measurement in rheumatologyTrials, 2007
- The Delirium Index, a Measure of the Severity of Delirium: New Findings on Reliability, Validity, and ResponsivenessJournal of the American Geriatrics Society, 2004
- The Richmond Agitation–Sedation ScaleAmerican Journal of Respiratory and Critical Care Medicine, 2002