Journal of Critical Care

Critical Care and Intensive Care Medicine
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  • Abstract: Objective unclear. What is meant by received? Mehods: What about the false negative categorizarion using ICD-9-CM codes Methods do not describe the methodology. It has only the definitions. Results: had more CAM-ICU assessments- more frequent of assessments or higher rating? Conclusion: What is the basis for the conclusion of over-sampling hyperactive/mixed, and under-sampling hypoactive Methods: Were any of these patients sedated or were on ventilator? Could that influence the categorization? Statistical Analysis: A Chi square test may not be adequate for the assessment of performance ICD-9-CM codes. Some goodness of fit tests may be require (caliberation) and test for discriminatory ability(c statistic) . How does the sensitivity analysis using modified the diagnostic criterion of delirium ≥2 positive CAMICU test robustness of the primary analysis. What is the rationale in using the changed criteria. If this was better then when why was the performance tested against a different criteria? Results: “and were more likely to require mechanical ventilation (P<0.001) and dialysis (P=0.004)”- were patients with delirium likely to require mechanical ventilation and dialysis or patients requiring these more likely to be delirious? Thirty-two patients had an ICD-9-CM code for delirium but did not have a positive CAM-ICU rating- could this result from including more codes as delirium –justify Discussion “metabolic encephalopathy” was one of the best predictors of the delirium, as 19% of patients with delirium (81/423) received this code. What is the basis for regarding “metabolic encephalopathy” as predictor? This was not assessed! “However, a sensitivity analysis limited the diagnosis of delirium to 2 or more CAM-ICU ratings supported the results of the primary analysis”? What do the authors mean by this over-sampling hyperactive/mixed type delirium patients? The specificity was high so why would there be over-sampling?

    Grammar Received documentation-? Do you mean were documented as delirious? Documentation of delirium was defined as- Was documentation defined or delirium defined? codes that was not the performance characteristics of 32 ICD9-CM codes for identifying delirium were a sensitivity of 36% and specificity of 95% We found that duration of delirium (larger counts of positive CAM-ICU ratings) and severe agitation were independent predictors of ICD- 9-CM codes for delirium-reframe the sentence. Independent predictor for being coded for delirium as per ICD-9-CM

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