Evidence map›Paper›PMID 30506177›Full record

ArticleNeurocritical care2019

Dispersion in Scores on the Richmond Agitation and Sedation Scale as a Measure of Delirium in Patients with Subdural Hematomas.

David Robinson, Stephanie Thompson, Andrew Bauerschmidt, Kara Melmed, Caroline Couch, Soojin Park, Sachin Agarwal, David Roh, E Sander Connolly, Jan Claassen

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurocritical care, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
0.3field-weighted citation impact, top 37% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 9 citations in OpenAlex.

  1. Review
  2. Article
  3. Modern Sedation and Analgesia Strategies in Neurocritical Care.Current neurology and neuroscience reports · 2023
    Review
  4. Observational
  5. Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 1 institution in 1 country.

David RobinsonDivision of Critical Care Neurology, Department of Neurology, Columbia University Medical Center, Milstein Hospital Building, 177 Fort Washington Avenue, 8-300 Center, New York, NY, 10032, USA.
Stephanie ThompsonDivision of Critical Care Neurology, Department of Neurology, Columbia University Medical Center, Milstein Hospital Building, 177 Fort Washington Avenue, 8-300 Center, New York, NY, 10032, USA.
Andrew BauerschmidtDivision of Critical Care Neurology, Department of Neurology, Columbia University Medical Center, Milstein Hospital Building, 177 Fort Washington Avenue, 8-300 Center, New York, NY, 10032, USA.
Kara MelmedDivision of Critical Care Neurology, Department of Neurology, Columbia University Medical Center, Milstein Hospital Building, 177 Fort Washington Avenue, 8-300 Center, New York, NY, 10032, USA.
Caroline CouchDivision of Critical Care Neurology, Department of Neurology, Columbia University Medical Center, Milstein Hospital Building, 177 Fort Washington Avenue, 8-300 Center, New York, NY, 10032, USA.
Soojin ParkDivision of Critical Care Neurology, Department of Neurology, Columbia University Medical Center, Milstein Hospital Building, 177 Fort Washington Avenue, 8-300 Center, New York, NY, 10032, USA.
Sachin AgarwalDivision of Critical Care Neurology, Department of Neurology, Columbia University Medical Center, Milstein Hospital Building, 177 Fort Washington Avenue, 8-300 Center, New York, NY, 10032, USA.
David RohDivision of Critical Care Neurology, Department of Neurology, Columbia University Medical Center, Milstein Hospital Building, 177 Fort Washington Avenue, 8-300 Center, New York, NY, 10032, USA.
E Sander ConnollyDepartment of Neurosurgery, Columbia University Medical Center, New York, NY, USA.
Jan ClaassenDivision of Critical Care Neurology, Department of Neurology, Columbia University Medical Center, Milstein Hospital Building, 177 Fort Washington Avenue, 8-300 Center, New York, NY, 10032, USA. jc1439@cumc.columbia.edu.
Columbia University Irving Medical Center · US

Funding

BIGDATA: Causal Inference in Large-Scale Time Series with Rare and Latent EventsR01LM011826 · NLM · THE TRUSTEES OF THE STEVENS INSTITUTE OF TECHNOLOGY · PI KLEINBERG, SAMANTHA · 2013 to 2024
$3.3M
NLM NIH HHS #R01LM011826NLM NIH HHS R01 LM011826
6 · The paper itself

Abstract

backgroundDelirium is a frequent complication of critical illness, but its diagnosis is more difficult in brain-injured patients due to language impairment and disorders of consciousness. We conducted a prospective cohort study to determine whether Richmond Agitation and Sedation Scale (RASS) scores could be used to reliably diagnose delirium in the setting of brain injury. We also examined clinical factors associated with delirium in patients with subdural hematomas (SDH) and assessed its impact on functional outcome at discharge.

methodsWe prospectively enrolled 55 patients with the primary diagnosis of SDH admitted to the neurological intensive care unit (ICU) and screened them for delirium with the Confusion Assessment Method-ICU (CAM-ICU). As our primary outcome, we examined whether the standard deviation of RASS scores (RASS dispersion) could be used to diagnose delirium. We also looked at trends in RASS scores as a way to distinguish different causes of delirium. Then, using logistic regression, we identified factors associated with delirium in patients with SDH and quantified the impact of delirium on the modified Rankin Scale at discharge.

resultsDelirium as defined by the CAM-ICU was present in 35% (N = 19) of patients. RASS dispersion correlated well with the CAM-ICU (AUC of the ROC was 0.84). Analyzing the temporal trend of changes in the RASS was helpful in identifying new brain injuries as the underlying etiology of CAM-ICU positivity. Age, APACHE II scores on admission, baseline functional impairment, midline shift on initial imaging, and infections were associated with an increased risk of delirium. Delirium was associated with a worse functional outcome.

conclusionsRASS dispersion correlates highly with CAM-ICU positivity, and monitoring trends in RASS scores can identify delirium caused by new brain injuries. Delirium as defined by the CAM-ICU is common in patients with SDH and portends worse outcomes.

Indexed as

Neuropsychological TestsAgedAged, 80 and overDeliriumHematoma, SubduralHumansMiddle AgedProspective StudiesPsychiatric Status Rating ScalesPsychomotor AgitationDeliriumSubdural hematomasTraumatic brain injury

Identifiers

PMID30506177
PMCPMC6520162
OpenAlexW2903062601

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.