[Confusion Assessment Method for diagnosing delirium in ICU patients (CAM-ICU): cultural adaptation and validation of the Spanish version]

E Tobar, C Romero, T Galleguillos, P Fuentes, R Cornejo, M T Lira, L de la Barrera, J E Sánchez, F Bozán, G Bugedo, A Morandi, Wesley E Ely
Medicina Intensiva 2010, 34 (1): 4-13

OBJECTIVE: To adapt the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for the diagnosis of delirium to the language and culture of Spain and to validate the adapted version.

DESIGN: Population validation.

SETTING: Intensive care units in a 600-bed university hospital.

PATIENTS: We studied 29 critical patients undergoing mechanical ventilation. Mean age was 70 years (range 58-77 years), mean APACHE II score 16 (range 13-21), and mean SOFA score 7 (range 4-8).

INTERVENTION: Two independent operators applied the Spanish version of the CAM-ICU and a psychiatrist applied the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition-Revised (DSM IV TR).

MAIN OUTCOME VARIABLES: Concordance (kappa index), internal consistency (Cronbach's alpha), and validity (sensitivity and specificity) of the Spanish version of the CAM-ICU were compared to the DSM IV TR, which is considered the current gold standard.

RESULTS: The translation and cultural adaptation was carried out in accordance with current international guidelines. A total of 65 assessments were performed in 29 patients. The interobserver concordance was high: kappa statistic 0.91 (95% CI: 0.86-0.96). The internal consistence was adequate: Cronbach's alpha=0.84 (unilateral 95% CI: 0.77). For observer A (a physician), the sensitivity of the Spanish version of the CAM-ICU was 80% and the specificity was 96%. For observer B, (a nurse) the sensitivity was 83% and the specificity was 96%.

CONCLUSIONS: The Spanish version of the CAM-ICU is a valid, reliable, and reproducible instrument that can be satisfactorily applied to diagnose delirium in Spanish-speaking ICU patients.

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