Routine use of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) by bedside nurses may underdiagnose delirium

Michael C Reade, Glenn M Eastwood, Leah Peck, Rinaldo Bellomo, Ian Baldwin
Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine 2011, 13 (4): 217-24

BACKGROUND: The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is emerging as the most frequently used tool for identifying delirium among critically ill patients.

OBJECTIVE: To determine whether the number of patients and nursing shifts in which delirium was diagnosed would increase after the introduction of the CAM-ICU in our unit.

DESIGN: Before-and-after study. In a 30-day Phase 1, we asked bedside nurses to assess their ICU patients for delirium each shift. We then conducted intensive education on the CAM-ICU for 30 days, including lectures, bedside tutorials, and supervised practice. In Phase 2, for 30 days we asked bedside nurses to record the results of their CAM-ICU assessments.

SETTING: 20-bed mixed medical and surgical ICU at the Austin Hospital, Melbourne.

PARTICIPANTS: All patients admitted to the ICU during each phase.

MAIN OUTCOME MEASURES: Diagnosis of delirium by bedside nurses using either the CAM-ICU or an unstructured clinical assessment, by patient and nursing shift.

RESULTS: Compared with unstructured assessments, the CAM-ICU identified a significantly lower proportion of patients (36.7% v 21.3%; P = 0.004) and a significantly lower proportion of shifts (14.7% v 6.4% of shifts, P = 0.002) with delirium. When adjusted for differences in age, sex, Acute Physiology and Chronic Health Evaluation III risk of death and total length of stay between the two periods, assessment type remained a significant predictor of the diagnosis of delirium.

CONCLUSIONS: In our hospital, the CAM-ICU detected delirium less often than unstructured delirium assessments made by qualified intensive care nurses.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"