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A6021 - Can CDT Scores on ICU Admission Predict Outcomes in Patients with Concurrent Negative CAM-ICU Results?
Author Block: K. C. Thandra1, J. Ogunmuyiwa2, G. Yang1, K. Tan1, H. Yulico1, A. Yesne1, J. Root1, B. Korc-Grodzicki1, A. Koshy1, N. Kostelecky1, K. matsoukas1, S. Chawla1, L. P. Voigt3; 1Memorial Sloan Kettering Cancer Center, New York, NY, United States, 2North East ohio medical university, Rootstown, OH, United States, 3Memorial Sloan-Kettering Cancer Ctr, New York, NY, United States.
Rationale: Delirium is associated with increased hospital and intensive care unit (ICU) length of stay (LOS), mortality, and long-term cognitive impairment. The confusion assessment method for the ICU (CAM-ICU) is one of two conventional tools for delirium screening in the ICU. Clock drawing test (CDT) is a validated tool of cognition assessment that has not been extensively studied in the ICU alone or in combination with CAM-ICU. The objective of this study is to evaluate the predictive role of CDT scores collected on ICU admission in a cohort of patients with negative CAM-ICU results on the first day of ICU admission. Methods: We prospectively administered CDT (Shulman method) and CAM-ICU to a cohort of patients within their first 24 hours of admission to an adult medical-surgical ICU at a tertiary cancer center between September 2016 and April 2017. CDT was scored by two experts from a range of 1-6 (1-2 as normal and 3-6 as abnormal). A third expert adjudicated only discrepant scores. Demographic and clinical characteristics were recorded and dyads of CDT/CAM-ICU results were correlated to patient’s outcomes. Univariable and multivariable logistic regression were used to determine association between CDT and ICU and hospital mortality and LOS. Prediction value of CDT was estimated as concordance index (c-index). Linear regression determined the relationship between CDT and LOS (log-transformed). Results: Of 337 ICU admissions, we excluded 24 ICU readmissions, 134 patients with “unable-to-assess” or positive CAM-ICU results, and 84 patients with incomplete data. The remaining 95 unique patients with simultaneous CDT and negative CAM-ICU collected on day 1 of ICU admission were analyzed: 55 (58%) with normal (1-2) CDT scores and 40 (42%) with abnormal (3-6) CDT scores. For patients with multiple CDT and CAM-ICU results, only the first recorded dyad was used in our analysis. CDT score (continuous version) was significantly associated with ICU mortality after adjusting for vasopressor use. Every unit increase in CDT score was associated with 1.83 fold increase in odds of ICU mortality (95% CI, 1.08-3.10; p=0.024) with excellent c-index of 0.8. Similar relationship was observed for hospital mortality, with 1.54-fold increase in odds of hospital death (95% CI, 1.04-2.27; p=0.030) with moderate c-index of 0.64. CDT was not significantly associated with ICU LOS (p=0.3) and hospital LOS (p=0.5). Conclusion: In a cohort of critically-ill cancer patients with negative CAM-ICU, CDT provides value in distinguishing patients who are at higher risk of ICU and hospital mortality.