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Detection of delirium in the intensive care unit: comparison of confusion assessment method for the intensive care unit with confusion assessment method ratings.
J Am Geriatr Soc. 2005 Mar; 53(3):495-500.JA

Abstract

OBJECTIVES

To compare the Confusion Assessment Method (CAM) and CAM for the Intensive Care Unit (CAM-ICU) methods for detecting delirium in alert, nonintubated older ICU patients.

DESIGN

Comparison study.

SETTING

Fourteen-bed medical ICU of an 800-bed university teaching hospital.

PARTICIPANTS

Twenty-two patients aged 65 and older admitted to the ICU.

MEASUREMENTS

Two blinded, trained clinician-researchers who had undergone interrater reliability testing interviewed patients separately, usually within 10 minutes of each other (up to 120 minutes). Each researcher examined patients for the four key CAM criteria: acuteness, inattention, disorganized thinking, and altered level of consciousness. One researcher used the CAM method with the Mini-Mental State Examination and Digit Span; the other researcher used the CAM-ICU method with nonverbal cognitive and attention tasks.

RESULTS

Rates of delirium were 68% according to CAM and 50% according CAM-ICU. Comparing the two methods, agreement was 82%, with a kappa of 0.64. Using the CAM as the reference standard, the CAM-ICU had a sensitivity of 73% (95% confidence interval (CI)=60-86) and specificity of 100% (95% CI=56-100). There were four false-negative ratings using the CAM-ICU. Reasons for disparate results were that the CAM used more-detailed cognitive testing that detected more deficits (3 patients) and the time elapsed (90 minutes) between ratings in one patient with markedly fluctuating symptoms.

CONCLUSION

CAM and CAM-ICU agreement was moderately high. Although the CAM-ICU is recommended for ICU patients because of its brevity and ease of use, the standard CAM method may detect more subtle cases of delirium in nonintubated, verbal ICU patients.

Authors+Show Affiliations

Department of Internal Medicine, School of Medicine, Brown University, Providence, Rhode Island, USA. Lynn_McNicoll@brown.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15743296

Citation

McNicoll, Lynn, et al. "Detection of Delirium in the Intensive Care Unit: Comparison of Confusion Assessment Method for the Intensive Care Unit With Confusion Assessment Method Ratings." Journal of the American Geriatrics Society, vol. 53, no. 3, 2005, pp. 495-500.
McNicoll L, Pisani MA, Ely EW, et al. Detection of delirium in the intensive care unit: comparison of confusion assessment method for the intensive care unit with confusion assessment method ratings. J Am Geriatr Soc. 2005;53(3):495-500.
McNicoll, L., Pisani, M. A., Ely, E. W., Gifford, D., & Inouye, S. K. (2005). Detection of delirium in the intensive care unit: comparison of confusion assessment method for the intensive care unit with confusion assessment method ratings. Journal of the American Geriatrics Society, 53(3), 495-500.
McNicoll L, et al. Detection of Delirium in the Intensive Care Unit: Comparison of Confusion Assessment Method for the Intensive Care Unit With Confusion Assessment Method Ratings. J Am Geriatr Soc. 2005;53(3):495-500. PubMed PMID: 15743296.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Detection of delirium in the intensive care unit: comparison of confusion assessment method for the intensive care unit with confusion assessment method ratings. AU - McNicoll,Lynn, AU - Pisani,Margaret A, AU - Ely,E Wesley, AU - Gifford,David, AU - Inouye,Sharon K, PY - 2005/3/4/pubmed PY - 2005/4/29/medline PY - 2005/3/4/entrez SP - 495 EP - 500 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 53 IS - 3 N2 - OBJECTIVES: To compare the Confusion Assessment Method (CAM) and CAM for the Intensive Care Unit (CAM-ICU) methods for detecting delirium in alert, nonintubated older ICU patients. DESIGN: Comparison study. SETTING: Fourteen-bed medical ICU of an 800-bed university teaching hospital. PARTICIPANTS: Twenty-two patients aged 65 and older admitted to the ICU. MEASUREMENTS: Two blinded, trained clinician-researchers who had undergone interrater reliability testing interviewed patients separately, usually within 10 minutes of each other (up to 120 minutes). Each researcher examined patients for the four key CAM criteria: acuteness, inattention, disorganized thinking, and altered level of consciousness. One researcher used the CAM method with the Mini-Mental State Examination and Digit Span; the other researcher used the CAM-ICU method with nonverbal cognitive and attention tasks. RESULTS: Rates of delirium were 68% according to CAM and 50% according CAM-ICU. Comparing the two methods, agreement was 82%, with a kappa of 0.64. Using the CAM as the reference standard, the CAM-ICU had a sensitivity of 73% (95% confidence interval (CI)=60-86) and specificity of 100% (95% CI=56-100). There were four false-negative ratings using the CAM-ICU. Reasons for disparate results were that the CAM used more-detailed cognitive testing that detected more deficits (3 patients) and the time elapsed (90 minutes) between ratings in one patient with markedly fluctuating symptoms. CONCLUSION: CAM and CAM-ICU agreement was moderately high. Although the CAM-ICU is recommended for ICU patients because of its brevity and ease of use, the standard CAM method may detect more subtle cases of delirium in nonintubated, verbal ICU patients. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/15743296/Detection_of_delirium_in_the_intensive_care_unit:_comparison_of_confusion_assessment_method_for_the_intensive_care_unit_with_confusion_assessment_method_ratings_ L2 - https://doi.org/10.1111/j.1532-5415.2005.53171.x DB - PRIME DP - Unbound Medicine ER -