title: Improved detection of delirium, implementation and validation of the CAM-ICU in elderly Emergency Department patients.
abstract: OBJECTIVE
  To evaluate the effect of routine use of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) on the diagnosis rate of delirium in elderly Emergency Department (ED) patients and the validity of the CAM-ICU in the ED setting.
  
  
  METHODS
  This was a prospective observational study in a tertiary care academic ED. We compared the diagnosis rate of delirium before implementation of the CAM-ICU, without routine use of a screening tool, with the diagnosis rate after implementation of the CAM-ICU. All consecutive patients aged 70 years or older were enrolled. The diagnosis rate before implementation was based on chart review and after implementation on a positive CAM-ICU score. In a subsample, the presence of delirium was evaluated independently according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR) criteria to assess the validity of the CAM-ICU.
  
  
  RESULTS
  The total study population included 968 patients: 490 before and 478 after implementation of the CAM-ICU. The two groups were not significantly different in patient characteristics. Before implementation of the CAM-ICU, delirium was diagnosed in 14 patients (3%) and after implementation in 48 patients (10%) (P<0.001). The sensitivity of the CAM-ICU for delirium in the ED setting was 100%, specificity was 98%, positive predictive value was 92%, and negative predictive value was 100%.
  
  
  CONCLUSIONS
  The diagnosis rate of delirium after implementation of the CAM-ICU was three-fold higher than before. The CAM-ICU is a reliable screening tool in the ED, with high sensitivity, specificity, and positive and negative predictive value.
authors.affiliation: Departments of aEmergency Medicine bGeriatrics, University Medical Center Groningen, Groningen, University of Groningen, The Netherlands.
authors.forename: Evelien K
authors.initials: EK
authors.lastname: Van de Meeberg
authors.forename: Suzanne
authors.initials: S
authors.lastname: Festen
authors.forename: Marieke
authors.initials: M
authors.lastname: Kwant
authors.forename: Rita R
authors.initials: RR
authors.lastname: Georg
authors.forename: Gerbrand J
authors.initials: GJ
authors.lastname: Izaks
authors.forename: Jan C
authors.initials: JC
authors.lastname: Ter Maaten
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis*; D042241:Early Diagnosis; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D058996:Quality Improvement; D018570:Risk Assessment; D012720:Severity of Illness Index