Validation of the Greek version of confusion assessment method for the intensive care unit (CAM-ICU)

Research and Academic Institute of Athens, Greece, 27 Themistokleous Street & Akadimias, Athens 106 77, Greece.
Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses 03/2012; 28(6). DOI: 10.1016/j.iccn.2012.02.003
Source: PubMed

ABSTRACT OBJECTIVES: Delirium is associated with the most adverse outcomes in critically ill patients but it is often undiagnosed and untreated. The Confusion Assessment Method for Intensive Care Unit (CAM-ICU) is widely used for delirium assessment. This scale, however, has not been translated and validated into the Greek language. This paper is a report of the translation and validation of the CAM-ICU into Greek. RESEARCH METHODOLOGY: The applicability and validity of CAM-ICU was tested in two Greek general ICUs. Each patient was included in the study only once. Inter-rater reliability and concurrent validity of both raters compared to the gold standard (DSM-IV) was calculated. RESULTS: Study sample consisted of 71 patients. Based on psychiatric diagnosis the prevalence of delirium was 33.8%. Compared to the reference standard for diagnosing delirium, the two study raters who used the CAM-ICU had sensitivities of 87.5% and 79.0%, specificities of 91.0% and 87.0%, and good inter-rater reliability (κ=0.75). Cronbach's alpha was 0.84 (95% CI 0.77-0.89). The mean CAM-ICU administration time was 6 minutes and 30 seconds. CONCLUSION: CAM-ICU seems to be a valid and reliable instrument for delirium detection in Greek intensive care patients, which can be easily incorporated in every day clinical practice after appropriate training.

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    • "On the other hand, the Italian CAM-ICU showed to have a slightly lower Ä value when compared to other versions of the tool. Indeed, excluding the value of 0.75 reported by Adamis et al. (2012), Ä varied from 0.79 (Toro et al., 2010) to 0.96 (Ely et al., 2001b; Guenther et al., 2010). Nonetheless, according to Landis and Koch (1977) a strength of agreement between 0.61 and 0.80 can be considered substantial. "
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    ABSTRACT: Objectives: To determine the psychometric properties of the Italian version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), a clinical assessment tool to detect delirium among Intensive Care Unit patients. Design: Validation study. Research methodology: Fifty-seven patients admitted to three medical and surgical Intensive Care Units were recruited. During the study interval two trained examiners performed independent delirium assessment by the CAM-ICU for a maximum of four times per patient. Main outcome measures: Interrater reliability and internal consistency of the tool, which were measured using Cohen's kappa and Cronbach's alpha coefficients respectively. Findings: Seventy-two paired evaluations were collected. The 35% of the studied cohort tested positive for delirium. The Italian version of the CAM-ICU demonstrated a substantial interrater reliability (kappa=0.76, p<0.0001) and a very good internal consistency (alpha = 0.87, 95% confidence interval: 0.81-0.91). Conclusion: The Italian CAM-ICU was found to be a viable instrument by which to approach a standardised monitoring of delirium among Italian speaking ICU patients. The use of such tools may facilitate ICU physicians and nurses in detecting delirium, thus improving both quality and safety of care.
    Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses 07/2014; 30(5). DOI:10.1016/j.iccn.2014.05.002
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    ABSTRACT: Delirium is common in the early stages of hospitalization for a variety of acute and chronic diseases. To evaluate the diagnostic accuracy of two delirium screening tools, the Confusion Assessment Method (CAM) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We searched MEDLINE, EMBASE, and PsychInfo for relevant articles published in English up to March 2013. We compared two screening tools to Diagnostic and Statistical Manual of Mental Disorders IV criteria. Two reviewers independently assessed studies to determine their eligibility, validity, and quality. Sensitivity and specificity were calculated using a bivariate model. Twenty-two studies (n = 2,442 patients) met the inclusion criteria. All studies demonstrated that these two scales can be administered within ten minutes, by trained clinical or research staff. The pooled sensitivities and specificity for CAM were 82% (95% confidence interval [CI]: 69%-91%) and 99% (95% CI: 87%-100%), and 81% (95% CI: 57%-93%) and 98% (95% CI: 86%-100%) for CAM-ICU, respectively. Both CAM and CAM-ICU are validated instruments for the diagnosis of delirium in a variety of medical settings. However, CAM and CAM-ICU both present higher specificity than sensitivity. Therefore, the use of these tools should not replace clinical judgment.
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    ABSTRACT: The management of pain, agitation, and delirium in critically ill patients can be complicated by multiple factors. Decisions to administer opioids, sedatives, and antipsychotic medications are frequently driven by a desire to facilitate patients’ comfort and their tolerance of invasive procedures or other interventions within the ICU. Despite accumulating evidence supporting new strategies to optimize pain, sedation, and delirium practices in the ICU, many critical care practitioners continue to embrace false perceptions regarding appropriate management in these critically ill patients. This article explores these perceptions in more detail and offers new evidence-based strategies to help critical care practitioners better manage sedation and delirium, particularly in ICU patients.
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