Delirium assessment using Confusion Assessment Method for the Intensive Care Unit in Chinese critically ill patients

Chunli Wang, Ying Wu, Peng Yue, E Wesley Ely, Jie Huang, Xin Yang, Yisi Liu
Journal of Critical Care 2013, 28 (3): 223-9

PURPOSE: The aim of this study was to provide a method for delirium evaluation in simplified Chinese for patients speaking this language via validation of a translation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).

MATERIALS AND METHODS: Two phases were conducted including initial reliability testing (phase I) of the Attention Screening Exam (ASE) followed by reliability and validity testing of the CAM-ICU (phase II). To analyze the reliability of the ASE, each patient was assessed sequentially by ASE Visual and ASE Auditory. The patients were assessed by 2 nurse investigators using CAM-ICU and 1 neurologist using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition separately within 2 hours in the second phase.

RESULTS: We found that the agreement between ASE Visual and ASE Auditory was high (κ = 0.83, P < .01, respectively). The educational level of the patients influenced the results of the inattention assessment, with the lower educational level of the patient yielding lower agreement on ASE. Even still, the κ consistencies were all above 0.61. The sensitivities of CAM-ICU were 91.8% and 93.4%, and the specificities were 90.8%and 87.7%, respectively. The interrater reliability of 2 nurse investigators was very high, with κ coefficient of 0.92 (P < .001).

CONCLUSIONS: This study affirmed the validity and reliability against reference raters using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition of a brief nursing-conducted method of diagnosing delirium in ICU patients who speak simplified Chinese using the CAM-ICU.

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