Yuji Koga1, Ryosuke Tsuruta2, Hiroaki Murata3, Koji Matsuo4, Tatsuhiko Ito5, E Wesley Ely6, Ayumi Shintani7, Hiroya Wakamatsu8, Masamitsu Sanui9, Hiroaki Yamase10. 1. Department of Nursing, Yamaguchi University Hospital, Yamaguchi, Japan. Electronic address: yuji-koga@umin.ac.jp. 2. Advanced Medical Emergency and Critical Care Center, Yamaguchi University, Yamaguchi, Japan. 3. Department of Nursing, Jikei University School of Medicine, Tokyo, Japan. 4. Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan. 5. Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan. 6. 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. 7. 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. 8. Department of Intensive Care, Yamaguchi University, Yamaguchi, Japan. 9. Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan. 10. Department of Clinical Nursing, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
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. RESEARCH METHODOLOGY: 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. CONCLUSION: 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.
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. RESEARCH METHODOLOGY: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. CONCLUSION: 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.