Intensive Care Medicine

, 34:1907 | Cite as

Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients

  • A. Morandi
  • P. Pandharipande
  • M. Trabucchi
  • R. Rozzini
  • G. Mistraletti
  • A. C. Trompeo
  • C. Gregoretti
  • L. Gattinoni
  • M. V. Ranieri
  • L. Brochard
  • D. Annane
  • C. Putensen
  • U. Guenther
  • P. Fuentes
  • E. Tobar
  • A. R. Anzueto
  • A. Esteban
  • Y. Skrobik
  • J. I. F. Salluh
  • M. Soares
  • C. Granja
  • A. Stubhaug
  • S. E. de Rooij
  • E. Wesley Ely
Clinical Commentary

Abstract

Background

Delirium (acute brain dysfunction) is a potentially life threatening disturbance in brain function that frequently occurs in critically ill patients. While this area of brain dysfunction in critical care is rapidly advancing, striking limitations in use of terminology related to delirium internationally are hindering cross-talk and collaborative research. In the English literature, synonyms of delirium such as the Intensive Care Unit syndrome, acute brain dysfunction, acute brain failure, psychosis, confusion, and encephalopathy are widely used. This often leads to scientific "confusion" regarding published data and methodology within studies, which is further exacerbated by organizational, cultural and language barriers.

Objective

We undertook this multinational effort to identify conflicts in terminology and phenomenology of delirium to facilitate communication across medical disciplines and languages.

Methods

The evaluation of the terminology used for acute brain dysfunction was determined conducting communications with 24 authors from academic communities throughout countries/regions that speak the 13 variants of the Romanic languages included into this manuscript.

Results

In the 13 languages utilizing Romanic characters, included in this report, we identified the following terms used to define major types of acute brain dysfunction: coma, delirium, delirio, delirium tremens, délire, confusion mentale, delir, delier, Durchgangs-Syndrom, acute verwardheid, intensiv-psykose, IVA-psykos, IVA-syndrom, akutt konfusion/forvirring. Interestingly two terms are very consistent: 100 % of the selected languages use the term coma or koma to describe patients unresponsive to verbal and/or physical stimuli, and 100% use delirium tremens to define delirium due to alcohol withdrawal. Conversely, only 54% use the term delirium to indicate the disorder as defined by the DSM-IV as an acute change in mental status, inattention, disorganized thinking and altered level of consciousness.

Conclusions

Attempts towards standardization in terminology, or at least awareness of differences across languages and specialties, will help cross-talk among clinicians and researchers.

Keywords

Delirium Delirio Delire Delier Delir Délire Confusion Confusione Coma Acute brain dysfunction Psychosis Delirium tremens Durchgangs-Syndrom Acute verwardheid 

Notes

Acknowledgments

We would like to thank Mrs. Patricia Lee, the medical librarian who conducted the literature search by which we generated the Figure 1, Dr. Ayumi Shintani PhD, the biostatistician who performed the P-value calculation, and Mr. Tim Peck, the graphic designer who generated the Figure 3 describing the delineation between coma and delirium.

Conflict of interest statement

None of the authors have any potential conflicts of interest as related to the content of this manuscript.

References

  1. 1.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. Text revision American Psychiatric Association, Washington, DCGoogle Scholar
  2. 2.
    McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK (2003) Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 51:591–598PubMedCrossRefGoogle Scholar
  3. 3.
    Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710PubMedCrossRefGoogle Scholar
  4. 4.
    Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y (2001) Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med 27:859–864PubMedCrossRefGoogle Scholar
  5. 5.
    Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW (2005) Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 9:R375–R381PubMedCrossRefGoogle Scholar
  6. 6.
    Peterson JF, Pun BT, Dittus RS, Thomason JW, Jackson JC, Shintani AK, Ely EW (2006) Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc 54:479–484PubMedCrossRefGoogle Scholar
  7. 7.
    Pandharipande P, Cotton BA, Shintani A, Thompson J, Costabile S, Truman PB, Dittus R, Ely EW (2007) Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients. Intensive Care Med 33:1726–1731PubMedCrossRefGoogle Scholar
  8. 8.
    Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, Inouye SK (2001) Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 29:1370–1379PubMedCrossRefGoogle Scholar
  9. 9.
    Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291:1753–1762PubMedCrossRefGoogle Scholar
  10. 10.
    Dubois MJ, Bergeron N, Dumont M, Dial S, Skrobik Y (2001) Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 27:1297–1304PubMedCrossRefGoogle Scholar
  11. 11.
    Inouye SK (1994) The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med 97:278–288PubMedCrossRefGoogle Scholar
  12. 12.
    Francis J, Kapoor WN (1990) Delirium in hospitalized elderly. J Gen Intern Med 5:65–79PubMedCrossRefGoogle Scholar
  13. 13.
    Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM, Donaldson MC, Whittemore AD, Sugarbaker DJ, Poss R (1994) A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 271:134–139PubMedCrossRefGoogle Scholar
  14. 14.
    Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P (1998) Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med 13:234–242PubMedCrossRefGoogle Scholar
  15. 15.
    Murray AM, Levkoff SE, Wetle TT (1993) Acute delirium and functional decline in the hospitalized elderly patient. J Gerontol 48:181Google Scholar
  16. 16.
    O’Keeffe S, Lavan J (1997) The prognostic significance of delirium in older hospital patients. J Am Geriatr Soc 45:174–178PubMedGoogle Scholar
  17. 17.
    Francis J, Kapoor WN (1992) Prognosis after hospital discharge of older medical patients with delirium. J Am Geriatr Soc 40:601–606PubMedGoogle Scholar
  18. 18.
    Marcantonio ER, Kiely DK, Simon SE, John OE, Jones RN, Murphy KM, Bergmann MA (2005) Outcomes of older people admitted to postacute facilities with delirium. J Am Geriatr Soc 53:963–969PubMedCrossRefGoogle Scholar
  19. 19.
    Bellelli G, Frisoni GB, Turco R, Lucchi E, Magnifico F, Trabucchi M (2007) Delirium superimposed on dementia predicts 12-month survival in elderly patients discharged from a postacute rehabilitation facility. J Gerontol A Biol Sci Med Sci 62:1306–1309PubMedGoogle Scholar
  20. 20.
    Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 33:66–73PubMedCrossRefGoogle Scholar
  21. 21.
    Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard R, Inouye SK (2001) The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 27:1892–1900PubMedCrossRefGoogle Scholar
  22. 22.
    Milbrandt EB, Deppen S, Harrison PL, Shintani AK, Speroff T, Stiles RA, Truman B, Bernard GR, Dittus RS, Ely EW (2004) Costs associated with delirium in mechanically ventilated patients. Crit Care Med 32:955–962PubMedCrossRefGoogle Scholar
  23. 23.
    Jackson JC, Gordon SM, Hart RP, Hopkins RO, Ely EW (2004) The association between delirium and cognitive decline: a review of the empirical literature. Neuropsychol Rev 14:87–98PubMedCrossRefGoogle Scholar
  24. 24.
    Inouye SK, Schlesinger MJ, Lydon TJ (1999) Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am J Med 106:565–573PubMedCrossRefGoogle Scholar
  25. 25.
    Cole MG, Primeau FJ (1993) Prognosis of delirium in elderly hospital patients. Can Med Assoc J 149:41–46Google Scholar
  26. 26.
    Rockwood K, Brown M, Merry H, Sketris I, Fisk J (2002) Societal costs of vascular cognitive impairment in older adults. Stroke 33:1605–1609PubMedCrossRefGoogle Scholar
  27. 27.
    Aguero-Torres H, von Strauss E, Viitanen M, Winblad B, Fratiglioni L (2001) Institutionalization in the elderly: the role of chronic diseases and dementia. Cross-sectional and longitudinal data from a population-based study. J Clin Epidemiol 54:795–801PubMedCrossRefGoogle Scholar
  28. 28.
    Cheung CZ, Alibhai SM, Robinson M, Tomlinson G, Chittock D, Drover J, Skrobik Y (2008) Recognition and labeling of delirium symptoms by intensivists: does it matter? Intensive Care Med 34:437–446PubMedCrossRefGoogle Scholar
  29. 29.
    Ely EW, Siegel MD, Inouye SK (2001) Delirium in the intensive care unit: an under-recognized syndrome of organ dysfunction. Semin Respir Crit Care Med 22:115–126PubMedCrossRefGoogle Scholar
  30. 30.
    Pandharipande P, Jackson J, Ely EW (2005) Delirium: acute cognitive dysfunction in the critically ill. Curr Opin Crit Care 11:360–368PubMedGoogle Scholar
  31. 31.
    Ebersoldt M, Sharshar T, Annane D (2007) Sepsis-associated delirium. Intensive Care Med 33:941–950PubMedCrossRefGoogle Scholar
  32. 32.
    Lipowski ZJ (1990) Delirium: acute confusional states, Revision edn. Oxford University Press, New YorkGoogle Scholar
  33. 33.
    Meagher DJ, Hanlon DO, Mahony EO, Casey PR, Trzepacz PT (2000) Relationship between symptoms and motoric subtype of delirium. J Neuropsychiatry Clin Neurosci 12:51–56PubMedGoogle Scholar
  34. 34.
    Marquis F, Ouimet S, Riker R, Cossette M, Skrobik Y (2007) Individual delirium symptoms: do they matter? Crit Care Med 35:2533–2537PubMedCrossRefGoogle Scholar
  35. 35.
    Ouimet S, Riker R, Bergeon N, Cossette M, Kavanagh B, Skrobik Y (2007) Subsyndromal delirium in the ICU: evidence for a disease spectrum. Intensive Care Med 33:1007–1013PubMedCrossRefGoogle Scholar
  36. 36.
    Marcantonio ER, Ta T, Duthrie E, Resnick NM (2002) Delirium severity and psychomotor types: their relationship with outcomes after hip fracture repair. J Am Geriatr Soc 50:850–857PubMedCrossRefGoogle Scholar
  37. 37.
    Cole M, McCusker J, Dendukuri N, Han L (2003) The prognostic significance of subsyndromal delirium in elderly medical inpatients. J Am Geriatr Soc 51:754–760PubMedCrossRefGoogle Scholar
  38. 38.
    Levkoff SE, Liptzin B, Cleary PD et al (1996) Subsyndromal delirium. Am J Geriatr Psychiatry 4:320–329Google Scholar
  39. 39.
    Levkoff SE, Yang FM, Liptzin B (2004) Delirium: the importance of subsyndromal states. Prim Psychiatry 11:40–44Google Scholar
  40. 40.
    Chadwick J, Mann MN (1950) The medical works of hippocrates. Blackwell, Oxford, pp 50, 223Google Scholar
  41. 41.
    Liston EH (1982) Delirium in the aged. Psychiatr Clin North Am 5:49–66PubMedGoogle Scholar
  42. 42.
    Laureys S, Owen AM, Schiff ND (2004) Brain function in coma, vegetative state, and related disorders. Lancet Neurol 3:537–546PubMedCrossRefGoogle Scholar
  43. 43.
    Wieck HH (1967) Lehrbuch für Psychiatrie. Schattauer, StuttgartGoogle Scholar
  44. 44.
    McGuire BE, Basten CJ, Ryan CJ, Gallagher J (2000) Intensive care unit syndrome: a dangerous misnomer. Arch Intern Med 160:906–909PubMedCrossRefGoogle Scholar
  45. 45.
    Granberg Axell AI, Malmros CW, Bergbom IL, Lundberg DB (2002) Intensive care unit syndrome/delirium is associated with anemia, drug therapy and duration of ventilation treatment. Acta Anaesthesiol Scand 46:726–731PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • A. Morandi
    • 1
    • 2
    • 3
  • P. Pandharipande
    • 4
  • M. Trabucchi
    • 3
  • R. Rozzini
    • 2
    • 3
  • G. Mistraletti
    • 5
  • A. C. Trompeo
    • 6
  • C. Gregoretti
    • 7
  • L. Gattinoni
    • 8
  • M. V. Ranieri
    • 6
  • L. Brochard
    • 9
  • D. Annane
    • 10
  • C. Putensen
    • 11
  • U. Guenther
    • 11
  • P. Fuentes
    • 12
  • E. Tobar
    • 13
  • A. R. Anzueto
    • 14
  • A. Esteban
    • 15
  • Y. Skrobik
    • 16
  • J. I. F. Salluh
    • 17
  • M. Soares
    • 17
  • C. Granja
    • 18
  • A. Stubhaug
    • 19
  • S. E. de Rooij
    • 20
  • E. Wesley Ely
    • 1
    • 21
    • 22
  1. 1.Center for Health Services ResearchNashvilleUSA
  2. 2.Department of Internal Medicine and GeriatricsPoliambulanza HospitalBresciaItaly
  3. 3.Geriatric Research GroupBresciaItaly
  4. 4.Division of Critical Care Medicine, Department of AnesthesiologyVanderbilt Medical CenterNashvilleUSA
  5. 5.Istituto di Anestesiologia e RianimazioneUniversità degli Studi di Milano, U.O. di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo, Polo UniversitarioMilanItaly
  6. 6.Intensive Care UnitMolinette Hospital, Universita’ di TorinoTorinoItaly
  7. 7.Intensive Care UnitAzienda Ospedaliera CTO-CRF-ICORMATorinoItaly
  8. 8.Istituto di Anestesiologia e RianimazioneUniversità degli Studi di Milano, U.O. di Anestesia e Rianimazione, Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena di MilanoMilanItaly
  9. 9.Réanimation Médicale, AP-HP, centre hospitalier Albert Chenevier, Henri MondorCréteilFrance
  10. 10.Service de réanimation, hôpital Raymond Poincaré (AP-HP)Université de VersaillesGarchesFrance
  11. 11.Department of Anesthesiology and Intensive Care MedicineUniversity Hospital Sigmund FreudBonnGermany
  12. 12.Geriatrics Section, Medicine DepartmentClinical Hospital University of ChileSantiagoChile
  13. 13.Medicina IntensivaHospital Clínico Universidad de ChileSantiagoChile
  14. 14.South Texas Veterans Health Care System, Audie L. Murphy DivisionThe University of Texas Health Science Center at San AntonioSan AntonioUSA
  15. 15.Intensive Care UnitHospital Universitario de Getafe, CIBER de Enfermedades RespiratoriasMadridSpain
  16. 16.Intensive Care UnitUniversité de Montréal, Hospital Maisonnevue-RosemontMontrealCanada
  17. 17.Intensive Care Unit, Centro de Tratamento IntensivoInstituto Nacional de Câncer, INCARio de JaneiroBrazil
  18. 18.Medical Intensive Care UnitHospital Pedro HispanoMatosinhosPortugal
  19. 19.Department of Anesthesiology and Intensive CareRikshopitalet University HospitalOsloNorway
  20. 20.Department of Geriatrics, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  21. 21.VA Tennessee Valley Geriatric ResearchEducation and Clinical Center (GRECC)NashvilleUSA
  22. 22.Division of Allergy/Pulmonary/Critical Care MedicineVanderbilt Medical CenterNashvilleUSA

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