• Am. J. Respir. Crit. Care Med. · Aug 2011

    Multicenter Study

    Routine use of the confusion assessment method for the intensive care unit: a multicenter study.

    • Maarten M van Eijk, Mark van den Boogaard, Rob J van Marum, Paul Benner, Piet Eikelenboom, Marina L Honing, Ben van der Hoven, Janneke Horn, Gerbrand J Izaks, Annette Kalf, Attila Karakus, Ine A Klijn, Michael A Kuiper, Frank-Erik de Leeuw, Tjarda de Man, Roos C van der Mast, Robert-Jan Osse, Sophia E de Rooij, Peter E Spronk, Peter H van der Voort, Willem A van Gool, and Arjen J Slooter.
    • Department of Intensive Care Medicine, University Medical Center Utrecht, The Netherlands.
    • Am. J. Respir. Crit. Care Med. 2011 Aug 1;184(3):340-4.

    RationaleDelirium 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.ObjectivesTo investigate the diagnostic value of the CAM-ICU in daily practice.MethodsTeams 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.Measurements And Main ResultsFifteen 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).ConclusionsSpecificity 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.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?

    User can't be blank.

    Content can't be blank.

    Content is too short (minimum is 15 characters).

    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…