Confusion assessment method for the intensive care unit (CAM-ICU): translation, retranslation and validation into Swedish intensive care settings

C Larsson, A Granberg Axell, A Ersson
Acta Anaesthesiologica Scandinavica 2007, 51 (7): 888-92

BACKGROUND: Becoming critical ill or severely injured leads to a process of worry, anxiety and pain. Patients in intensive care sometimes have strange and frightening experiences and may show symptoms of acute confusion or delirium. CAM-ICU, the confusion assessment method for the intensive care unit, was based on the DSM IV, the Diagnostic and Statistic Manual of Mental Disorders IV, and today, healthcare professionals and researchers are increasingly accepting this concept of diagnosing ICU delirium. In Sweden, there is no commonly used, single instrument or method to test the development of ICU delirium. The aim of this study was to translate, retranslate and validate CAM-ICU for use in Swedish ICU settings.

METHODS: The translation of the instrument was done according to the guidelines suggested by The Translation and Cultural Adaptation group which includes preparation, forward translation/reconciliation, back translation, back translation review, harmonization, cognitive debriefing and validation. In the validation process, the applicability of the Swedish version of the instruments was tested in a Swedish intensive care unit.

RESULTS: Fourteen adult patients were included in the study, 40 paired tests were carried out, and 80 CAM-ICU instruments were completed. The participating patients were given CAM-ICU ratings using independent paired evaluations by two nurses, specialized in intensive care, at least twice during the patients' stay in the ICU. Interrater reliability was calculated using kappa statistics. In the 40 paired observations, interrater reliability was 'very good' (kappa statistics > 0.81). In our material, we recognized a delirium rate of 48%, which is in accordance with previous studies.

CONCLUSION: The translation of the instrument CAM-ICU showed good correlation with the original version and could therefore be applicable in a Swedish ICU setting. In the 40 paired observations, interrater reliability was very good. Although there are limitations in using CAM-ICU, previous studies reveal a need for a homogeneous screening instrument making it possible to detect and determine ICU delirium; and from this basis are able to implement and make the necessary decisions required in medical and nursing care practice preventing ICU delirium.

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