title: Reliability and validity assessment of the Japanese version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).
abstract: OBJECTIVE
  Delirium may lead to adverse outcomes in patients with serious conditions, but is often under-diagnosed due to inadequate screening. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is an established method for assessing delirium in the ICU. The validity and reliability of the Japanese version of the CAM-ICU has not, however, been verified, and we undertook this study to verify these parameters.
  
  
  METHODS
  CAM-ICU validity and reliability were assessed in two Japanese ICUs. Using the evaluation of the DMS-IV-TR in the psychiatrists group as the standard criteria for delirium diagnosis, we compared the evaluation of the Japanese version of the CAM-ICU between the research nurses group and the staff nurses group.
  
  
  RESULTS
  According to DSM-IV-TR criteria, the prevalence of delirium was 22.0%, and according to CAM-ICU delirium was found in 22.0% with Research Nurses and 19.5% with Staff Nurses. CAM-ICU sensitivity ratings were 83% and 78%, while their specificity ratings were 95% and 97%, respectively. The Kappa inter-rater reliability was good (κ=0.85), and Cronbach's alpha coefficient was 0.69 (95% CI: 0.57-0.79). Mean rating time for the CAM-ICU was 2.5-2.8 minutes for Research Nurses and Staff Nurses, respectively.
  
  
  CONCLUSIONS
  The Japanese version of the CAM-ICU has comparable validity and reliability as a delirium assessment tool in surgical patients in two Japanese ICUs. With training, CAM-ICU can be incorporated into daily clinical practice.
authors.affiliation: Department of Nursing, Yamaguchi University Hospital, Yamaguchi, Japan. Electronic address: yuji-koga@umin.ac.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Koga
authors.affiliation: Advanced Medical Emergency and Critical Care Center, Yamaguchi University, Yamaguchi, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tsuruta
authors.affiliation: Department of Nursing, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Murata
authors.affiliation: Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine Center for Health Services Research, Vanderbilt School of Medicine, Nashville, TN, USA; Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, USA.
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, USA; Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, USA; Center for Quantitative Sciences, Vanderbilt University School of Medicine, Nashville, USA.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Shintani
authors.affiliation: Department of Intensive Care, Yamaguchi University, Yamaguchi, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Wakamatsu
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Sanui
authors.affiliation: Department of Clinical Nursing, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yamase
mesh_terms: D000368:Aged; D003221:Confusion / Q000175:diagnosis* / Q000451:nursing; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007362:Intensive Care Units; D007564:Japan; D008297:Male; D009483:Neuropsychological Tests; D009733:Nursing Diagnosis; D015203:Reproducibility of Results; D014177:Translations
keywords: CAM-ICU; Delirium; ICU; Japan; Reliability; Validity