title: Routine use of the confusion assessment method for the intensive care unit: a multicenter study.
abstract: BACKGROUND
  Delirium is often unrecognized in ICU patients and associated with poor outcome. Screening for ICU delirium is recommended by several medical organizations to improve early diagnosis and treatment. The Confusion Assessment Method for the ICU (CAM-ICU) has high sensitivity and specificity for delirium when administered by research nurses. However, test characteristics of the CAM-ICU as performed in routine practice are unclear.
  
  
  OBJECTIVE
  To investigate the diagnostic value of the CAM-ICU in daily practice.
  
  
  METHODS
  Teams of three delirium experts including psychiatrists, geriatricians, and neurologists visited 10 ICUs twice. Based on cognitive examination, inspection of medical files, and Diagnostic and Statistic Manual of Mental Disorders, 4th edition, Text Revision criteria for delirium, the expert teams classified patients as awake and not delirious, delirious, or comatose. This served as a gold standard to which the CAM-ICU as performed by the bedside ICU-nurses was compared. Assessors were unaware of each other's conclusions.
  
  
  RESULTS
  Fifteen delirium experts assessed 282 patients of whom 101 (36%) were comatose and excluded. In the remaining 181 (64%) patients, the CAM-ICU had a sensitivity of 47% (95% confidence interval [CI], 35%-58%); specificity of 98% (95% CI, 93%-100%); positive predictive value of 95% (95% CI, 80%-99%); and negative predictive value of 72% (95% CI, 64%-79%). The positive likelihood ratio was 24.7 (95% CI, 6.1-100) and the negative likelihood ratio was 0.5 (95% CI, 0.4-0.8).
  
  
  CONCLUSIONS
  Specificity of the CAM-ICU as performed in routine practice seems to be high but sensitivity is low. This hampers early detection of delirium by the CAM-ICU.
authors.affiliation: Department of Intensive Care Medicine, University Medical Center Utrecht, The Netherlands.
authors.forename: Maarten M
authors.initials: MM
authors.lastname: van Eijk
authors.forename: Mark
authors.initials: M
authors.lastname: van den Boogaard
authors.forename: Rob J
authors.initials: RJ
authors.lastname: van Marum
authors.forename: Paul
authors.initials: P
authors.lastname: Benner
authors.forename: Piet
authors.initials: P
authors.lastname: Eikelenboom
authors.forename: Marina L
authors.initials: ML
authors.lastname: Honing
authors.forename: Ben
authors.initials: B
authors.lastname: van der Hoven
authors.forename: Janneke
authors.initials: J
authors.lastname: Horn
authors.forename: Gerbrand J
authors.initials: GJ
authors.lastname: Izaks
authors.forename: Annette
authors.initials: A
authors.lastname: Kalf
authors.forename: Attila
authors.initials: A
authors.lastname: Karakus
authors.forename: Ine A
authors.initials: IA
authors.lastname: Klijn
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuiper
authors.forename: Frank-Erik
authors.initials: FE
authors.lastname: de Leeuw
authors.forename: Tjarda
authors.initials: T
authors.lastname: de Man
authors.forename: Roos C
authors.initials: RC
authors.lastname: van der Mast
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: Osse
authors.forename: Sophia E
authors.initials: SE
authors.lastname: de Rooij
authors.forename: Peter E
authors.initials: PE
authors.lastname: Spronk
authors.forename: Peter H
authors.initials: PH
authors.lastname: van der Voort
authors.forename: Willem A
authors.initials: WA
authors.lastname: van Gool
authors.forename: Arjen J
authors.initials: AJ
authors.lastname: Slooter
mesh_terms: D018806:APACHE; D003422:Critical Care / Q000379:methods / Q000592:standards*; D003693:Delirium / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D009426:Netherlands; D012680:Sensitivity and Specificity