Routine Use of the Confusion Assessment Method for the Intensive Care Unit: A Multicenter Study
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 deliriu...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2011-08, Vol.184 (3), p.340-344 |
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| creator | VAN EIJK, Maarten M VAN DEN BOOGAARD, Mark KARAKUS, Attila KLIJN, Ine A KUIPER, Michael A DE LEEUW, Frank-Erik DE MAN, Tjarda VAN DER MAST, Roos C OSSE, Robert-Jan DE ROOIJ, Sophia E SPRONK, Peter E VAN DER VOORT, Peter H VAN MARUM, Rob J VAN GOOL, Willem A SLOOTER, Arjen J BENNER, Paul EIKELENBOOM, Piet HONING, Marina L VAN DER HOVEN, Ben HORN, Janneke IZAKS, Gerbrand J KALF, Annette |
| description | 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.
To investigate the diagnostic value of the CAM-ICU in daily practice.
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.
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).
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. |
| doi_str_mv | 10.1164/rccm.201101-0065OC |
| format | Article |
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To investigate the diagnostic value of the CAM-ICU in daily practice.
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.
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).
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.</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.201101-0065OC</identifier><identifier>PMID: 21562131</identifier><language>eng</language><publisher>New York, NY: American Thoracic Society</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; APACHE ; Biological and medical sciences ; Clinical death. Palliative care. Organ gift and preservation ; Consciousness ; Critical care ; Critical Care - methods ; Critical Care - standards ; Delirium ; Delirium - diagnosis ; Female ; Humans ; Intensive care ; Intensive care medicine ; Intensive Care Units - standards ; Male ; Mass Screening - methods ; Mass Screening - standards ; Medical sciences ; Mental disorders ; Middle Aged ; Netherlands ; Nurses ; Patients ; Psychiatrists ; Sensitivity and Specificity</subject><ispartof>American journal of respiratory and critical care medicine, 2011-08, Vol.184 (3), p.340-344</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright American Thoracic Society Aug 1, 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c310t-69ab5d53fee10d632768761e0727578ee4b9f72ea3d092cbd4c6a44b8a691eec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,4011,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24425370$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21562131$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>VAN EIJK, Maarten M</creatorcontrib><creatorcontrib>VAN DEN BOOGAARD, Mark</creatorcontrib><creatorcontrib>KARAKUS, Attila</creatorcontrib><creatorcontrib>KLIJN, Ine A</creatorcontrib><creatorcontrib>KUIPER, Michael A</creatorcontrib><creatorcontrib>DE LEEUW, Frank-Erik</creatorcontrib><creatorcontrib>DE MAN, Tjarda</creatorcontrib><creatorcontrib>VAN DER MAST, Roos C</creatorcontrib><creatorcontrib>OSSE, Robert-Jan</creatorcontrib><creatorcontrib>DE ROOIJ, Sophia E</creatorcontrib><creatorcontrib>SPRONK, Peter E</creatorcontrib><creatorcontrib>VAN DER VOORT, Peter H</creatorcontrib><creatorcontrib>VAN MARUM, Rob J</creatorcontrib><creatorcontrib>VAN GOOL, Willem A</creatorcontrib><creatorcontrib>SLOOTER, Arjen J</creatorcontrib><creatorcontrib>BENNER, Paul</creatorcontrib><creatorcontrib>EIKELENBOOM, Piet</creatorcontrib><creatorcontrib>HONING, Marina L</creatorcontrib><creatorcontrib>VAN DER HOVEN, Ben</creatorcontrib><creatorcontrib>HORN, Janneke</creatorcontrib><creatorcontrib>IZAKS, Gerbrand J</creatorcontrib><creatorcontrib>KALF, Annette</creatorcontrib><title>Routine Use of the Confusion Assessment Method for the Intensive Care Unit: A Multicenter Study</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>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.
To investigate the diagnostic value of the CAM-ICU in daily practice.
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.
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).
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.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>APACHE</subject><subject>Biological and medical sciences</subject><subject>Clinical death. Palliative care. Organ gift and preservation</subject><subject>Consciousness</subject><subject>Critical care</subject><subject>Critical Care - methods</subject><subject>Critical Care - standards</subject><subject>Delirium</subject><subject>Delirium - diagnosis</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units - standards</subject><subject>Male</subject><subject>Mass Screening - methods</subject><subject>Mass Screening - standards</subject><subject>Medical sciences</subject><subject>Mental disorders</subject><subject>Middle Aged</subject><subject>Netherlands</subject><subject>Nurses</subject><subject>Patients</subject><subject>Psychiatrists</subject><subject>Sensitivity and Specificity</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpd0E1rFTEUBuAgFvuhf8CFBEG6mpqTzxl3l4sfhZaCWnAXMpkzdMpMUpOM0H_f1Hu10FXO4nnPCS8hb4GdAWj5MXm_nHEGwKBhTKur7QtyBEqoRnaGvawzM6KRsvt1SI5zvmUMeAvsFTnkoDQHAUfEfo9rmQLS64w0jrTcIN3GMK55ioFucsacFwyFXmK5iQMdY_przkPBkKc_VbtU02Eqn-iGXq5zmXz1mOiPsg73r8nB6OaMb_bvCbn-8vnn9ltzcfX1fLu5aLwAVhrduV4NSoyIwAYtuNGt0YDMcKNMiyj7bjQcnRhYx30_SK-dlH3rdAeIXpyQ093euxR_r5iLXabscZ5dwLhm27bMgIKurfL9M3kb1xTq5yoCaeo9XhHfIZ9izglHe5emxaV7C8w-lm8fy7e78u2u_Bp6t9-89gsO_yP_2q7gwx647N08Jhf8lJ-clFwJw8QDtjmM3Q</recordid><startdate>20110801</startdate><enddate>20110801</enddate><creator>VAN EIJK, Maarten M</creator><creator>VAN DEN BOOGAARD, Mark</creator><creator>KARAKUS, Attila</creator><creator>KLIJN, Ine A</creator><creator>KUIPER, Michael A</creator><creator>DE LEEUW, Frank-Erik</creator><creator>DE MAN, Tjarda</creator><creator>VAN DER MAST, Roos C</creator><creator>OSSE, Robert-Jan</creator><creator>DE ROOIJ, Sophia E</creator><creator>SPRONK, Peter E</creator><creator>VAN DER VOORT, Peter H</creator><creator>VAN MARUM, Rob J</creator><creator>VAN GOOL, Willem A</creator><creator>SLOOTER, Arjen J</creator><creator>BENNER, Paul</creator><creator>EIKELENBOOM, Piet</creator><creator>HONING, Marina L</creator><creator>VAN DER HOVEN, Ben</creator><creator>HORN, Janneke</creator><creator>IZAKS, Gerbrand J</creator><creator>KALF, Annette</creator><general>American Thoracic Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20110801</creationdate><title>Routine Use of the Confusion Assessment Method for the Intensive Care Unit: A Multicenter Study</title><author>VAN EIJK, Maarten M ; VAN DEN BOOGAARD, Mark ; KARAKUS, Attila ; KLIJN, Ine A ; KUIPER, Michael A ; DE LEEUW, Frank-Erik ; DE MAN, Tjarda ; VAN DER MAST, Roos C ; OSSE, Robert-Jan ; DE ROOIJ, Sophia E ; SPRONK, Peter E ; VAN DER VOORT, Peter H ; VAN MARUM, Rob J ; VAN GOOL, Willem A ; SLOOTER, Arjen J ; BENNER, Paul ; EIKELENBOOM, Piet ; HONING, Marina L ; VAN DER HOVEN, Ben ; HORN, Janneke ; IZAKS, Gerbrand J ; KALF, Annette</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c310t-69ab5d53fee10d632768761e0727578ee4b9f72ea3d092cbd4c6a44b8a691eec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>APACHE</topic><topic>Biological and medical sciences</topic><topic>Clinical death. Palliative care. Organ gift and preservation</topic><topic>Consciousness</topic><topic>Critical care</topic><topic>Critical Care - methods</topic><topic>Critical Care - standards</topic><topic>Delirium</topic><topic>Delirium - diagnosis</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units - standards</topic><topic>Male</topic><topic>Mass Screening - methods</topic><topic>Mass Screening - standards</topic><topic>Medical sciences</topic><topic>Mental disorders</topic><topic>Middle Aged</topic><topic>Netherlands</topic><topic>Nurses</topic><topic>Patients</topic><topic>Psychiatrists</topic><topic>Sensitivity and Specificity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>VAN EIJK, Maarten M</creatorcontrib><creatorcontrib>VAN DEN BOOGAARD, Mark</creatorcontrib><creatorcontrib>KARAKUS, Attila</creatorcontrib><creatorcontrib>KLIJN, Ine A</creatorcontrib><creatorcontrib>KUIPER, Michael A</creatorcontrib><creatorcontrib>DE LEEUW, Frank-Erik</creatorcontrib><creatorcontrib>DE MAN, Tjarda</creatorcontrib><creatorcontrib>VAN DER MAST, Roos C</creatorcontrib><creatorcontrib>OSSE, Robert-Jan</creatorcontrib><creatorcontrib>DE ROOIJ, Sophia E</creatorcontrib><creatorcontrib>SPRONK, Peter E</creatorcontrib><creatorcontrib>VAN DER VOORT, Peter H</creatorcontrib><creatorcontrib>VAN MARUM, Rob J</creatorcontrib><creatorcontrib>VAN GOOL, Willem A</creatorcontrib><creatorcontrib>SLOOTER, Arjen J</creatorcontrib><creatorcontrib>BENNER, Paul</creatorcontrib><creatorcontrib>EIKELENBOOM, Piet</creatorcontrib><creatorcontrib>HONING, Marina L</creatorcontrib><creatorcontrib>VAN DER HOVEN, Ben</creatorcontrib><creatorcontrib>HORN, Janneke</creatorcontrib><creatorcontrib>IZAKS, Gerbrand J</creatorcontrib><creatorcontrib>KALF, Annette</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>VAN EIJK, Maarten M</au><au>VAN DEN BOOGAARD, Mark</au><au>KARAKUS, Attila</au><au>KLIJN, Ine A</au><au>KUIPER, Michael A</au><au>DE LEEUW, Frank-Erik</au><au>DE MAN, Tjarda</au><au>VAN DER MAST, Roos C</au><au>OSSE, Robert-Jan</au><au>DE ROOIJ, Sophia E</au><au>SPRONK, Peter E</au><au>VAN DER VOORT, Peter H</au><au>VAN MARUM, Rob J</au><au>VAN GOOL, Willem A</au><au>SLOOTER, Arjen J</au><au>BENNER, Paul</au><au>EIKELENBOOM, Piet</au><au>HONING, Marina L</au><au>VAN DER HOVEN, Ben</au><au>HORN, Janneke</au><au>IZAKS, Gerbrand J</au><au>KALF, Annette</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Routine Use of the Confusion Assessment Method for the Intensive Care Unit: A Multicenter Study</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Am J Respir Crit Care Med</addtitle><date>2011-08-01</date><risdate>2011</risdate><volume>184</volume><issue>3</issue><spage>340</spage><epage>344</epage><pages>340-344</pages><issn>1073-449X</issn><eissn>1535-4970</eissn><abstract>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.
To investigate the diagnostic value of the CAM-ICU in daily practice.
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.
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).
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.</abstract><cop>New York, NY</cop><pub>American Thoracic Society</pub><pmid>21562131</pmid><doi>10.1164/rccm.201101-0065OC</doi><tpages>5</tpages></addata></record> |
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| identifier | ISSN: 1073-449X |
| ispartof | American journal of respiratory and critical care medicine, 2011-08, Vol.184 (3), p.340-344 |
| issn | 1073-449X 1535-4970 |
| language | eng |
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| source | MEDLINE; American Thoracic Society (ATS) Journals Online; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy APACHE Biological and medical sciences Clinical death. Palliative care. Organ gift and preservation Consciousness Critical care Critical Care - methods Critical Care - standards Delirium Delirium - diagnosis Female Humans Intensive care Intensive care medicine Intensive Care Units - standards Male Mass Screening - methods Mass Screening - standards Medical sciences Mental disorders Middle Aged Netherlands Nurses Patients Psychiatrists Sensitivity and Specificity |
| title | Routine Use of the Confusion Assessment Method for the Intensive Care Unit: A Multicenter Study |
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