Validity and reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients.
OBJECTIVE
Delirium occurs frequently in critical care but often remains undiagnosed because delirium monitoring is often dismissed as being too time-consuming. This study determined the validity and reliability of the "CAM-ICU Flowsheet," a practical, time-sparing algorithm to assess the 4 delirium criteria in intubated patients.


METHODS
With permission from our institution's ethics committee, patients of a 31-bed surgical intensive care unit department were screened for delirium (1) by a psychiatrist as the reference rater using the 4 delirium criteria of the Diagnostic and Statistical Manual of Mental Diseases, Fourth Edition (DSM-IV), and (2) by 2 physician investigators using a German translation of the CAM-ICU Flowsheet.


RESULTS
Fifty-four surgical ICU patients underwent the complete protocol assessment with paired observations; 46% were diagnosed with delirium by the reference rater (n = 25), 9% had hyperactive delirium (n = 5), and 37% were hypoactive (n = 20). The CAM-ICU Flowsheet investigators had sensitivities of 88% (95% confidence interval, 69%-98%) and 92% (74%-99%), specificities of 100% (85%-100%), very high interrater reliability (kappa, 0.96; 0.87-1.00), and needed 50 seconds (interquartile range, 40-120 seconds) in patients with delirium vs 45 seconds (interquartile range, 40-75 seconds) in those without delirium to complete assessments.


CONCLUSIONS
The CAM-ICU Flowsheet has high sensitivity, high specificity, and very high interrater reliability. False-negative ratings can occur infrequently and mostly reflect the fluctuating course of delirium. The CAM-ICU Flowsheet is a valid, reliable, and quickly performed bedside delirium instrument.
Guenther
Ulf
U
Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Germany. u.guenther@uni-bonn.de
Popp
Julius
J
Koecher
Lena
L
Muders
Thomas
T
Wrigge
Hermann
H
Ely
E Wesley
EW
Putensen
Christian
C
D000367:Age Factors; D000368:Aged; D000465:Algorithms; D003422:Critical Care / Q000379:methods*; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity