Research ArticleResearch

Routine nurse delirium charting only moderately matched expert ICU assessments

Critical Care Medicine (PubMed)Dec 1, 2025

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

Routine bedside-nurse delirium documentation agreed only moderately with structured expert assessments in the ICU, and adding clinical context improved accuracy.

What NurseJet pulled from the source

Across 1535 paired assessments in 279 critically ill adults, agreement between bedside nurses' routine ICDSC screening (score of 4 or higher) and trained researchers' CAM-ICU assessments was only moderate (Cohen's kappa 0.42). A model that combined the individual ICDSC components with mechanical ventilation status and admission SOFA score predicted expert-confirmed delirium well (AUC 0.87; F1 0.72 on cross-validation), and the plain pass/fail cutoff performed worst of the models tested.

Why this matters for nurses

Delirium is common and harmful in the ICU, and routine charted screens are what downstream teams and registries rely on. This may matter because a single pass/fail nurse score may not capture delirium as well as a structured expert assessment, so a borderline screen that drives sedation, mobility, or escalation decisions is best read alongside the whole clinical picture rather than as a standalone verdict.

Bedside takeaway

Be aware that routine pass/fail ICDSC charting agreed only moderately with expert delirium assessments, so a borderline screen reads best alongside the whole clinical picture, not as a standalone verdict.

Key takeaways

Agreement between routine nurse ICDSC documentation and researcher CAM-ICU was moderate (Cohen's kappa 0.42) across 1535 assessments in 279 patients.
A model combining ICDSC components with ventilation status and admission SOFA score discriminated delirium well (AUC 0.87; F1 0.72).
The simple validated cutoff alone performed worst; richer component-level detail improved accuracy.
Patients were critically ill adults with acute respiratory failure or sepsis in academic-hospital ICUs.

Practice implications

Score every ICDSC component deliberately instead of rushing to a single pass/fail number, and when a screen sits near the threshold, corroborate it with your own bedside picture of attention, fluctuation, and level of consciousness. Use complete, accurate delirium documentation to support ABCDEF/ICU Liberation discussions about lightening sedation and early mobility.

Limitations & cautions

This was a single health-system, academic-ICU sample focused on respiratory failure and sepsis, so it may not generalize to all units. The optimized model was only internally validated by cross-validation and has not been tested prospectively, so real-world bedside performance is unproven.
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Critical Care Medicine (PubMed)

Critical Care Medicine (PubMed). Optimizing Agreement Between Bedside Nurse-Documented and Trained Researcher Delirium Assessments in the ICU.

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https://pubmed.ncbi.nlm.nih.gov/40970763/

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This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Western journal of nursing research (PubMed)Oct 15, 2026Systematic Review

A systematic review and meta-analysis of 38 studies including 19,033 patients identified clinical severity scales—specifically Modified Fisher grade and Fisher grade—and hemodynamic status as the strongest predictors of cerebral vasospasm following subarachnoid hemorrhage.

Emergency ICUAI summaryReview source

Systematic ReviewResearchQuality ImprovementAI summary · original source linked below

Cerebral vasospasm is a severe complication of aneurysmal subarachnoid hemorrhage (SAH) that frequently precipitates delayed cerebral ischemia and increases patient mortality. To clarify clinical predictors and inform intensive care nursing assessments, investigators conducted a systematic review and meta-analysis across eight databases through August 2024, evaluating study quality with the Joanna Briggs Institute checklist and Risk of Bias 2.0 tool. Across 38 included studies (27 in the meta-analysis) encompassing 19,033 patients, clinical severity metrics showed the strongest association with cerebral vasospasm: Modified Fisher grade (odds ratio [OR] 2.88; 95% CI, 2.04–4.07), Fisher grade (OR 2.27; 95% CI, 1.91–2.69), and hemodynamic status (OR 2.56; 95% CI, 1.17–5.59). Aneurysm-related characteristics and comorbid conditions were also linked to increased vasospasm risk, whereas clinical biomarkers and inflammatory markers demonstrated comparatively smaller effect sizes.

Key takeaways

Systematic review and meta-analysis synthesized 38 studies (27 in meta-analysis) encompassing 19,033 patients after subarachnoid hemorrhage.
Radiographic and clinical severity scales showed the strongest association with cerebral vasospasm: Modified Fisher grade (OR 2.88; 95% CI, 2.04–4.07) and Fisher grade (OR 2.27; 95% CI, 1.91–2.69).
Hemodynamic instability was strongly associated with vasospasm risk (OR 2.56; 95% CI, 1.17–5.59).
Aneurysm features and comorbidities also increased risk, while clinical biomarkers and inflammatory markers demonstrated smaller effect sizes.

Why this matters on shift

Neurocritical care nurses are the first line of defense in detecting subtle neurological deterioration and hemodynamic shifts in patients hospitalized for subarachnoid hemorrhage. Understanding that initial Fisher grade and hemodynamic status carry the highest statistical odds for vasospasm reinforces rigorous serial neurological scoring and strict blood pressure monitoring during the peak vasospasm window.

Bedside takeaway

In a meta-analysis of 19,033 SAH patients, Modified Fisher grade (OR 2.88), Fisher grade (OR 2.27), and hemodynamic status (OR 2.56) were the strongest predictors of cerebral vasospasm.

Nursing implications

Identify admission Fisher or Modified Fisher scores during shift handoff, maintain strict hemodynamic parameters per provider orders, and immediately escalate focal neurological deficits, altered sensorium, or transcranial Doppler velocity increases.

Limitations & cautions

Synthesized observational studies with heterogeneous definitions and reporting standards; meta-analysis reflects statistical associations rather than prospective causal prediction models; abstract does not detail specific individual biomarker cutoff values.
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Citations · exact source links

Western journal of nursing research (PubMed). Key Predictors of Cerebral Vasospasm Following Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.

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Clinical research in cardiology : official journal of the German Cardiac Society (PubMed)Sep 28, 2026Research Article

A prespecified sex-specific secondary analysis of the PUSH-AHF trial in 310 patients found natriuresis-guided diuretic therapy increased 24-hour sodium excretion and reduced 180-day mortality or heart failure readmission in men, but not in women.

Telemetry ICUAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

Natriuresis-guided loop diuretic titration uses spot urinary sodium measurements to tailor decongestive therapy in acute heart failure (AHF). In this sex-specific analysis of the randomized PUSH-AHF trial, investigators evaluated 310 patients (45% women) assigned to natriuresis-guided therapy versus standard of care. In men, natriuresis-guided therapy produced significantly greater mean 24-hour total natriuresis compared with standard care (443 vs 354 mmol, p = 0.004), whereas women showed no significant difference between treatment arms (357 vs 336 mmol, p = 0.533; adjusted p-interaction = 0.276). Notably, the median 24-hour natriuretic response per milligram of loop diuretic (bumetanide equivalents) was significantly lower in women receiving natriuresis-guided therapy than standard care (23 vs 52 mmol/mg, p = 0.001), while no difference was observed in men (38 vs 45 mmol/mg, p = 0.337; adjusted p-interaction = 0.009). Clinically, natriuresis guidance was associated with a 49% lower risk of 180-day all-cause mortality or HF rehospitalization in men (adjusted HR 0.51; 95% CI, 0.30–0.86; p = 0.011), but showed no benefit in women (adjusted HR 1.40; 95% CI, 0.67–2.91; p = 0.368; adjusted p-interaction = 0.026).

Key takeaways

Sex-specific analysis of the PUSH-AHF randomized trial evaluated 310 patients (45% women) with acute heart failure.
In men, natriuresis-guided therapy increased 24-hour urinary sodium excretion (443 vs 354 mmol, p = 0.004) and reduced 180-day mortality/rehospitalization by 49% (adjusted HR 0.51, p = 0.011).
In women, natriuresis guidance did not increase total natriuresis (357 vs 336 mmol, p = 0.533) or improve 180-day clinical outcomes (adjusted HR 1.40, p = 0.368; p-interaction = 0.026).
Women in the guided arm exhibited a blunted natriuretic response per milligram of loop diuretic (23 vs 52 mmol/mg bumetanide, p = 0.001).

Why this matters on shift

Cardiology and telemetry nurses frequently manage intensive loop diuretic infusions and collect spot urinary sodium samples during acute decompensated heart failure admissions. These findings demonstrate that diuretic responsiveness and natriuresis-guided protocols may operate differently by biological sex, warning clinicians that intensifying diuretic doses based solely on spot sodium targets may not yield uniform decongestive or prognostic benefits across all patient groups.

Bedside takeaway

In the PUSH-AHF trial (310 patients), natriuresis-guided diuretic therapy reduced 180-day mortality/readmission in men (aHR 0.51) but showed no benefit in women (aHR 1.40; p-interaction=0.026).

Nursing implications

Collect urine samples for spot sodium strictly at ordered intervals during acute decongestion, maintain accurate intake/output records, monitor serum electrolytes and renal function closely during diuretic uptitration, and recognize that blunted urinary sodium output in female patients may reflect altered pharmacodynamics rather than simple noncompliance with fluid restrictions.

Limitations & cautions

Post-hoc subgroup analysis of a randomized trial with limited sample size (n = 310, including 139 women); findings are hypothesis-generating and require prospective validation in sex-stratified clinical trials before modifying clinical guidelines.
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Citations · exact source links

Clinical research in cardiology : official journal of the German Cardiac Society (PubMed). Effects of natriuresis-guided diuretic therapy in men and women with acute heart failure: insights from PUSH-AHF.

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Critical care medicine (PubMed)Oct 1, 2026Research Article

A multicenter randomized controlled trial across three hospitals found that deploying specialized nurse communication facilitators during and after an ICU admission did not reduce family member depressive symptoms over 6 months.

ICU Med-SurgAI summaryReview source

Research ArticleResearchQuality ImprovementWorkflowAI summary · original source linked below

Family members of critically ill patients frequently experience severe psychological distress, fragmented communication during handoffs, and difficulties achieving care aligned with patient values. This multicenter randomized controlled trial evaluated a structured nurse communication facilitator intervention across three hospitals in Seattle, Washington. Investigators enrolled 449 ICU patients with chronic life-limiting illness or high hospital mortality risk (>15%) and 505 family members, randomized at the patient level to standard care (n = 224) or intervention (n = 225). Nurse communication facilitators were trained to support, model, and coach communication strategies to promote goal-concordant care throughout the ICU stay and for three months post-randomization. The primary outcome was family member depression measured by the Hospital Anxiety and Depression Scale (HADS) over six months. Mean HADS-depression scores declined over time in both groups (baseline 7.2 vs 5.9 at 6 months), with no statistically significant difference between groups (mean difference -0.07; 95% CI -0.70 to 0.55). Small secondary improvements favored the intervention for relationship with the healthcare team (p = 0.0162) and goal concordance (p = 0.0504), but effect sizes were modest.

Key takeaways

Multicenter trial randomized 449 critically ill patients and 505 family members across three hospital centers.
Dedicated nurse communication facilitators engaging families for 3 months post-ICU did not significantly reduce 6-month depression (difference -0.07; 95% CI -0.70 to 0.55).
Family depressive symptoms declined equally over time in both intervention and standard care arms (from 7.2 to 5.9).
Secondary endpoints showed modest positive gains in relationship with the care team (p = 0.0162) and goal concordance (p = 0.0504).

Why this matters on shift

ICU bedside nurses invest substantial time providing emotional support and interpreting complex clinical updates for grieving families. This rigorous trial demonstrates that standalone nurse communication facilitators do not prevent post-intensive care depression, indicating that psychological morbidity requires broader multidisciplinary mental health support rather than communication coaching alone.

Bedside takeaway

In a multicenter RCT of 505 family members of ICU patients, nurse communication facilitators did not reduce 6-month depression scores (-0.07 difference, 95% CI -0.70 to 0.55), despite modest gains in team trust.

Nursing implications

Maintain empathetic, goal-aligned bedside communication during daily interprofessional rounds, but recognize the limits of communication interventions alone in preventing family depression; advocate for early palliative care, social work, and formal psychological support referrals for high-distress families.

Limitations & cautions

Conducted within a single regional health system; high attrition in questionnaire response rates at 6 months; baseline depression scores were relatively mild, potentially limiting the detectable margin of improvement.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Critical care medicine (PubMed). Facilitating Communication for Family Members of Critically Ill Patients During and Following a Hospital Stay: A Randomized Controlled Trial.

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AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Meta-analysis of 19,033 SAH patients identifies clinical severity and hemodynamics as top predictors of cerebral vasospasm

PUSH-AHF trial analysis finds natriuresis-guided diuretic therapy reduces 180-day events in men but not women with acute heart failure

Multicenter RCT finds specialized nurse communication facilitators did not reduce family depression after ICU stay