← All public profiles

ICDSC: Intensive Care Delirium Screening Checklist

2001

An eight-item delirium checklist for intensive care, combining focused bedside assessment with observations over time. Arousal determines whether assessment is possible.

At a glance

Purpose
Episodic assessment
Population
Adult
Setting
Intensive care, Perioperative
Time
includes bedside assessment plus observations over 8–24 hours, depending on the item and version
Items
8
Score or threshold
0–8; ≥4 is the standard positive-screen threshold

Format: The eight items produce a total from 0 to 8. The Tufts 2013 worksheet combines a focused assessment for the first four items with observations for the remaining items, including relevant information from the preceding 24 hours. Deeply sedated or comatose patients are not assessable. A score of 4 or more is the usual positive-screen threshold.

  • Strengths: Uses observations accumulated across a nursing shift and can support repeated screening when a brief point-in-time interview may miss fluctuation
  • Limitations: A positive screen is not an independent diagnosis. Accuracy varies across settings and studies, and interpretation depends on training, observation quality, arousal and sedation state, communication constraints and use of the intended observation window. Alternative thresholds require local validation.

Primary validation papers

26 identified diagnostic-accuracy papers

Other forms of validation are described in the evidence section. What is counted?

Large-scale clinical implementation

Reports identified: read the commentary

Selected primary reports and Penfold et al. (2024); not a completed census.

Training and instructions

  • ICDSC checklist and instructions. Public ICU Delirium resource directory. Open the resource with this tool’s name; versions are listed separately.
  • ICDSC form. Public instrument material checked on 5 September 2026. Follow the source’s version and permission conditions.
Start here

Tool and original sources

View the ICDSC on the Vanderbilt CIBS site. It is not reproduced here.

View the tool ↗ Official information and permissions ↗

Original and selected diagnostic-accuracy papers

  • Original paperBergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive care medicine. 2001;27(5):859-64. doi: 10.1007/s001340100909. PMID: 11430542.

    This original study developed and evaluated ICDSC in 93 medical-surgical intensive-care patients against an independent psychiatrist DSM-IV assessment. It reported ROC-estimated sensitivity of 99% and specificity of 64%; separately, 14 of 15 delirium cases and 15 of 78 non-delirium cases scored at least four, so the ROC pair should not be treated as observed diagnostic cells.

    Open PubMed ↗
  • Systematic review of diagnostic accuracyGusmao-Flores D, Salluh JI, Chalhub RÁ, Quarantini LC. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Critical care (London, England). 2012;16(4):R115. doi: 10.1186/cc11407. PMID: 22759376.

    This systematic review synthesised diagnostic-accuracy evidence for ICDSC. Across 4 studies involving 361 patients for ICDSC, pooled sensitivity was 74% and specificity was 81.9%.

    Open PubMed ↗Download article PDF ↓

    Article PDF: CC BY. This licence applies to the article PDF and does not grant rights to reproduce the tool.

  • Selected diagnostic-accuracy studyvan Eijk MM, van Marum RJ, Klijn IA, de Wit N, Kesecioglu J, Slooter AJ. Comparison of delirium assessment tools in a mixed intensive care unit. Critical care medicine. 2009;37(6):1881-5. doi: 10.1097/CCM.0b013e3181a00118. PMID: 19384206.

    This diagnostic-accuracy study evaluated ICDSC in 32-bed mixed medical-surgical ICU against diagnosis by a psychiatrist, neurologist or geriatrician using established criteria. It reported sensitivity of 43% and specificity of 95% in 126 patients.

    Open PubMed ↗
Pooled diagnostic-accuracy evidenceCore instrument family
Classification

Classification

Episodic assessmentUse in intensive care unitsMonitoring for new onset delirium

A tool may belong to more than one category. Select a linked category to see other relevant profiles.

Evidence

Diagnostic-accuracy evidencePooled diagnostic-accuracy evidence

Reported sensitivity and specificity

Headline metric source

Original/source study · 2001; pmid:11430542

Denominator
93 patients
Reference standard
Independent consulting board-certified psychiatrist's clinical DSM-IV delirium diagnosis
99%
Sensitivity
64%
Specificity

The original 2001 study (93 patients) reported 99% sensitivity and 64% specificity as ROC-estimated performance at ICDSC >=4. The observed classifications were 14/15 delirium cases and 15/78 non-delirium cases scoring >=4; do not reconstruct or substitute one result type for the other. Later pooled estimates are shown below.

Expanded evidence profile

What the broader evidence shows

Interpretation: ICDSC is an eight-item adult intensive-care screening checklist that accumulates observations across a nursing shift. Pooled studies suggest moderate-to-good sensitivity and high specificity, but results vary with threshold, observation quality, sedation, communication and neurological deficits; a positive screen is not a diagnosis and a negative score does not safely exclude delirium.

Evidence snapshots

  • Original study, observed classifications (2001): From the reported counts, observed sensitivity was 93.3% and specificity 80.8%; the paper separately reported ROC-estimated sensitivity 99% and specificity 64%.
  • Early diagnostic meta-analysis (2012): Across four studies and 361 patients, pooled sensitivity was 74% and specificity 81.9%.
  • Bivariate meta-analysis (2021): Across 12 ICDSC studies, pooled sensitivity was 83% and specificity 87%.
  • Updated diagnostic meta-analysis (2024): Across 14 ICDSC studies, pooled sensitivity was 79% and specificity 90%.

These results come from different populations and workflows and should not be averaged or treated as interchangeable.

9 selected PubMed-indexed papers, 2001–2026
  1. 2001Original development and validation study
    Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27(5):859-864. doi: 10.1007/s001340100909. PMID: 11430542.

    The eight-item ICDSC was evaluated in 93 medical-surgical intensive-care patients, 15 of whom received an independent psychiatrist diagnosis of delirium after a 24-hour observation window. Fourteen of 15 delirium cases and 15 of 78 non-delirium cases scored at least four, whereas the separately modelled ROC result was sensitivity 99% and specificity 64%; these two result types should not be conflated.

    PubMed · PMID 11430542 ↗
  2. 2009Diagnostic-accuracy study
    van Eijk MM, van Marum RJ, Klijn IA, de Wit N, Kesecioglu J, Slooter AJ. Comparison of delirium assessment tools in a mixed intensive care unit. Crit Care Med. 2009;37(6):1881-1885. doi: 10.1097/CCM.0b013e3181a00118. PMID: 19384206.

    In 126 mixed medical-surgical intensive-care patients, trained nurses applied ICDSC independently of psychiatrist, geriatrician or neurologist reference assessment. ICDSC sensitivity was 43% and specificity 95%, illustrating that high specificity can coexist with substantial under-detection.

    PubMed · PMID 19384206 ↗
  3. 2012Systematic review and meta-analysis
    Gusmao-Flores D, Salluh JI, Chalhub RA, Quarantini LC. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Crit Care. 2012;16(4):R115. doi: 10.1186/cc11407. PMID: 22759376.

    This early diagnostic meta-analysis included four ICDSC studies and 361 adult intensive-care patients assessed against DSM-IV criteria. Pooled sensitivity was 74% and specificity 81.9%, supporting screening use but not exclusion of delirium after a negative score.

    PubMed · PMID 22759376 ↗
  4. 2017Diagnostic-accuracy study
    Boettger S, Garcia Nuñez D, Meyer R, Richter A, Fernandez SF, Rudiger A, et al. Delirium in the intensive care setting: A reevaluation of the validity of the CAM-ICU and ICDSC versus the DSM-IV-TR in determining a diagnosis of delirium as part of the daily clinical routine. Palliat Support Care. 2017;15(6):675-683. doi: 10.1017/S1478951516001176. PMID: 28173895.

    This routine prospective cohort included 210 patients with matched ICDSC, CAM-ICU and DSM-IV-TR assessments. ICDSC sensitivity was 63% and specificity 95%, again showing that a negative routine score did not refute delirium.

    PubMed · PMID 28173895 ↗
  5. 2018Diagnostic-accuracy study
    Boettger S, Garcia Nuñez D, Meyer R, Richter A, Rudiger A, Schubert M, et al. Screening for delirium with the Intensive Care Delirium Screening Checklist (ICDSC): a re-evaluation of the threshold for delirium. Swiss Med Wkly. 2018;148:w14597. doi: 10.4414/smw.2018.14597. PMID: 29537480.

    In 289 intensive-care patients including 122 with DSM-IV-TR delirium, reported sensitivity changed from 83% at a threshold of at least three to 62% at four and 44% at five. Lowering the threshold increased detection at the cost of over-identification, while internally inconsistent classification percentages in the report warrant caution about reconstructing diagnostic cells.

    PubMed · PMID 29537480 ↗
  6. 2020Diagnostic-accuracy study
    Reznik ME, Drake J, Margolis SA, Moody S, Murray K, Costa S, et al. Deconstructing Poststroke Delirium in a Prospective Cohort of Patients With Intracerebral Hemorrhage. Crit Care Med. 2020;48(1):111-118. doi: 10.1097/CCM.0000000000004031. PMID: 31567406.

    A neurointensivist completed 257 daily reference-standard assessments in 60 intracerebral-haemorrhage patients, many with aphasia or verbally unassessable features. ICDSC sensitivity was 77% and specificity 97%, but this single-centre neurological result should not be generalised to all intensive-care populations.

    PubMed · PMID 31567406 ↗
  7. 2021Systematic review and meta-analysis
    Chen TJ, Chung YW, Chang HR, Chen PY, Wu CR, Hsieh SH, et al. Diagnostic accuracy of the CAM-ICU and ICDSC in detecting intensive care unit delirium: A bivariate meta-analysis. Int J Nurs Stud. 2021;113:103782. doi: 10.1016/j.ijnurstu.2020.103782. PMID: 33120134.

    This bivariate diagnostic meta-analysis identified 12 ICDSC studies and assessed multiple potential performance modifiers. Pooled sensitivity was 83% and specificity 87%, with heterogeneity related to delirium subtype, intensive-care type, ventilation and participant characteristics.

    PubMed · PMID 33120134 ↗
  8. 2024Systematic review and meta-analysis
    Diao Y, Yu X, Zhang Q, Chen X. The predictive value of confusion assessment method-intensive care unit and intensive care delirium screening checklist for delirium in critically ill patients in the intensive care unit: A systematic review and meta-analysis. Nurs Crit Care. 2024;29(6):1224-1235. doi: 10.1111/nicc.13064. PMID: 38538305.

    This updated diagnostic meta-analysis searched through January 2024 and included 14 ICDSC studies among 32 eligible articles. Pooled ICDSC sensitivity was 79% and specificity 90%, with a hierarchical summary receiver-operating-characteristic area of 0.92.

    PubMed · PMID 38538305 ↗
  9. 2026Diagnostic-accuracy study
    Somarajan D, Prakash R, Chellamma J, Shelley NS, Anand A, James TG, et al. Diagnostic Accuracy of CAM-ICU and ICDSC for Detection of Early Delirium in Acute Ischemic Stroke: A Cross-sectional Study. Ann Indian Acad Neurol. 2026;29(1):59-66. doi: 10.4103/aian.aian_925_25. PMID: 41559862.

    This prospective study compared ICDSC and CAM-ICU with DSM-5 criteria in 164 acute ischaemic-stroke patients, 32.3% of whom developed early post-stroke delirium. ICDSC sensitivity was 70% and specificity 86%, and specificity fell markedly in patients with higher-order cognitive deficits such as aphasia or neglect.

    PubMed · PMID 41559862 ↗

This is a selected evidence overview, not a systematic review. Nine papers were chosen to preserve the original validation, lower-sensitivity routine findings, a threshold study, neurological cohorts and the strongest tool-relevant meta-analyses through 2026; all nine records were checked in PubMed and Scite on 30 August 2026, and no selected record surfaced under the retraction, concern, correction or erratum filters used.

More evidence and citation details
Full name
Intensive Care Delirium Screening Checklist
Training
Users should understand delirium, arousal and sedation assessment, the observation window and the authorised scoring instructions. Standardised education and local competency checking are advisable.
Evidence summary
Systematic reviews and multiple diagnostic-accuracy studies
Diagnostic-accuracy evaluations
26
Reference standard
Independent consulting psychiatrist's clinical DSM-IV delirium diagnosis
Reliability
;
Real-world use
Used at scale in general-hospital as well as ICU settings; real-world completion and positivity vary with setting and stage of implementation. (Penfold 2024)
Citation
Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y Intensive Care Delirium Screening Checklist: evaluation of a new screening tool Intensive care medicine. 2001;27(5):859-64. PMID 11430542
Download RIS ↗ Download BibTeX ↗

Primary validation studies

Distinct primary publications from the current diagnostic-accuracy audit. Reviews and repeated evaluations within one paper are not counted again. Overlapping cohorts have not all been reconciled. Read the counting rules and limitations.

Open 26 identified papers
  1. Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y (2001). Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive care medicine.

    Reference category: independent clinical reference.

  2. Radtke FM, Franck M, Oppermann S, Lütz A, Seeling M, Heymann A, Kleinwächter R, Kork F, Skrobik Y, Spies CD (2009). [The Intensive Care Delirium Screening Checklist (ICDSC)--translation and validation of intensive care delirium checklist in accordance with guidelines]. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS.

    Reference category: other comparator or secondary accuracy evidence.

  3. van Eijk MM, van Marum RJ, Klijn IA, de Wit N, Kesecioglu J, Slooter AJ (2009). Comparison of delirium assessment tools in a mixed intensive care unit. Critical care medicine.

    Reference category: independent clinical reference.

  4. George C, Nair JS, Ebenezer JA, Gangadharan A, Christudas A, Gnanaseelan LK, Jacob KS (2011). Validation of the Intensive Care Delirium Screening Checklist in nonintubated intensive care unit patients in a resource-poor medical intensive care setting in South India. Journal of critical care.

    Reference category: independent clinical reference.

  5. Neufeld KJ, Hayat MJ, Coughlin JM, Huberman AL, Leistikow NA, Krumm SK, Needham DM (2011). Evaluation of two intensive care delirium screening tools for non-critically ill hospitalized patients. Psychosomatics.

    Reference category: independent clinical reference.

  6. Gusmao-Flores D, Salluh JI, Dal-Pizzol F, Ritter C, Tomasi CD, Lima MA, Santana LR, Lins RM, Lemos PP, Serpa GV, Oliveira J, Chalhub RÁ, Pitrowsky MT, Lacerda AL, Koenen KC, Quarantini LC (2011). The validity and reliability of the Portuguese versions of three tools used to diagnose delirium in critically ill patients. Clinics (Sao Paulo, Brazil).

    Reference category: independent clinical reference.

  7. Gian Domenico G, Piergentili F (2012). Cultural and linguistic validation of the Italian version of the intensive care delirium screening checklist. Dimensions of critical care nursing : DCCN.

    Reference category: other comparator or secondary accuracy evidence.

  8. Kose G, Bolu A, Ozdemir L, Acikel C, Hatipolu S (2016). Reliability and Validity of the Intensive Care Delirium Screening Checklist in Turkish. International journal of nursing knowledge.

    Reference category: independent clinical reference.

  9. Nishimura K, Yokoyama K, Yamauchi N, Koizumi M, Harasawa N, Yasuda T, Mimura C, Igita H, Suzuki E, Uchiide Y, Seino Y, Nomura M, Yamazaki K, Ishigooka J, TMAD investigators (2016). Sensitivity and specificity of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for detecting post-cardiac surgery delirium: A single-center study in Japan. Heart & lung : the journal of critical care.

    Reference category: independent clinical reference.

  10. Boettger S, Nuñez DG, Meyer R, Richter A, Fernandez SF, Rudiger A, Schubert M, Jenewein J (2017). Delirium in the intensive care setting: A reevaluation of the validity of the CAM-ICU and ICDSC versus the DSM-IV-TR in determining a diagnosis of delirium as part of the daily clinical routine. Palliative & supportive care.

    Reference category: independent clinical reference.

  11. Barman A, Pradhan D, Bhattacharyya P, Dey S, Bhattacharjee A, Tesia SS, Mitra JK (2018). Diagnostic accuracy of delirium assessment methods in critical care patients. Journal of critical care.

    Reference category: other comparator or secondary accuracy evidence.

  12. Chanques G, Ely EW, Garnier O, Perrigault F, Eloi A, Carr J, Rowan CM, Prades A, de Jong A, Moritz-Gasser S, Molinari N, Jaber S (2018). The 2014 updated version of the Confusion Assessment Method for the Intensive Care Unit compared to the 5th version of the Diagnostic and Statistical Manual of Mental Disorders and other current methods used by intensivists. Annals of intensive care.

    Reference category: independent clinical reference.

  13. Boettger S, Garcia Nuñez D, Meyer R, Richter A, Rudiger A, Schubert M, Jenewein J (2018). Screening for delirium with the Intensive Care Delirium Screening Checklist (ICDSC): a re-evaluation of the threshold for delirium. Swiss medical weekly.

    Reference category: independent clinical reference.

  14. Larsen LK, Frøkjaer VG, Nielsen JS, Skrobik Y, Winkler Y, Møller K, Petersen M, Egerod I (2019). Delirium assessment in neuro-critically ill patients: A validation study. Acta anaesthesiologica Scandinavica.

    Reference category: independent clinical reference.

  15. Al-Qadheeb NS, Nazer LH, Aisa TM, Osman HO, Rugaan AS, Alzahrani AS, Ghonimat IM, Mohammed AM, Maghrabi K, Alrowaished AA, Hussein NH, Maslamani YA, Falatah S, Skrobik Y (2019). Arabic intensive care delirium screening checklist's validity and reliability: A multicenter study. Journal of critical care.

    Reference category: independent clinical reference.

  16. Boßelmann C, Zurloh J, Stefanou MI, Stadler V, Weber Y, Lerche H, Poli S, Ziemann U, Mengel A (2019). Delirium Screening in Aphasic Patients With the Intensive Care Delirium Screening Checklist (ICDSC): A Prospective Cohort Study. Frontiers in neurology.

    Reference category: independent clinical reference.

  17. Reznik ME, Drake J, Margolis SA, Moody S, Murray K, Costa S, Mahta A, Wendell LC, Thompson BB, Rao SS, Barrett AM, Boukrina O, Daiello LA, Asaad WF, Furie KL, Jones RN (2020). Deconstructing Poststroke Delirium in a Prospective Cohort of Patients With Intracerebral Hemorrhage. Critical care medicine.

    Reference category: independent clinical reference.

  18. von Hofen-Hohloch J, Awissus C, Fischer MM, Michalski D, Rumpf JJ, Classen J (2020). Delirium Screening in Neurocritical Care and Stroke Unit Patients: A Pilot Study on the Influence of Neurological Deficits on CAM-ICU and ICDSC Outcome. Neurocritical care.

    Reference category: independent clinical reference.

  19. Detroyer E, Timmermans A, Segers D, Meyfroidt G, Dubois J, Van Assche A, Joosten E, Milisen K (2020). Psychometric properties of the intensive care delirium screening checklist when used by bedside nurses in clinical practice: a prospective descriptive study. BMC nursing.

    Reference category: other comparator or secondary accuracy evidence.

  20. Nacul FE, Paul N, Spies CD, Sechting H, Hecht T, Dullinger JS, Piper SK, Luetz A, Balzer FS, Wernecke KD, Sa AK, Barros Ferreira da Costa C, Eymold L, Chenitir C, Weiss B (2020). Influence of Sedation Level and Ventilation Status on the Diagnostic Validity of Delirium Screening Tools in the ICU-An International, Prospective, Bi-Center Observational Study (IDeAS). Medicina (Kaunas, Lithuania).

    Reference category: independent clinical reference.

  21. Hana Locihová, Karel Axmann (2022). Comparing the CAM-ICU and ICDSC for assessing delirium in non-intubated intensive care patients. Central European Journal of Nursing and Midwifery.

    Reference category: other comparator or secondary accuracy evidence.

  22. Weiss B, Paul N, Spies CD, Ullrich D, Ansorge I, Salih F, Wolf S, Luetz A (2022). Influence of Patient-Specific Covariates on Test Validity of Two Delirium Screening Instruments in Neurocritical Care Patients (DEMON-ICU). Neurocritical care.

    Reference category: independent clinical reference.

  23. van den Boogaard M, Leenders M, Pop-Purceleanu M, Tilburgs B (2024). Performance and validation of two ICU delirium assessment and severity tools; a prospective observational study. Intensive & critical care nursing.

    Reference category: other comparator or secondary accuracy evidence.

  24. Bakošová L, Kec D, Škorňa M, Jura R, Kundrata Z, Košťálová M, Bednařík J (2024). Screening and differential diagnosis of delirium in neurointensive stroke patients. Heliyon.

    Reference category: independent clinical reference.

  25. Breit H, Panos NG, Fisher K, Blackwood A, Yeager C, Schachter M, Michalopoulos G, Petry LG, Da Silva I, John S (2025). Delirium screening in the neurointensive care unit: Comparison of the confusion assessment method for the intensive care unit and intensive care delirium screening checklist. Journal of the neurological sciences.

    Reference category: other comparator or secondary accuracy evidence.

  26. Somarajan D, Prakash R, Chellamma J, Shelley NS, Anand A, James TG, Mangalanandan N, Mathews AM, Fletcher NE (2026). Diagnostic Accuracy of CAM-ICU and ICDSC for Detection of Early Delirium in Acute Ischemic Stroke: A Cross-sectional Study. Annals of Indian Academy of Neurology.

    Reference category: independent clinical reference.

Copyright and reuse
Version
Use the current ICDSC worksheet supplied by CIBS
Information checked
2026-07-19

Instrument-specific terms apply. See the access and copyright policy or send a correction.

Base clinical review: 2026-08-30. Instrument description source check: 2026-09-05. Scope and limitations.