Abstract
BackgroundDelirium is common in critically ill patients and it is associated with poor outcomes. In Tunisia, however, it is still underdiagnosed as there is no validated screening tool. The aim of this study was to translate and to validate a Tunisian version of the CAM-ICU.MethodsFor the validation and inter-rater reliability assessment of the Tunisian CAM-ICU, two trained intensivists independently evaluated delirium in the patients admitted to the ICU between October 2017 and June 2018. All the patients consecutively admitted to the ICU for more than 24 h and having a Richmond Agitation-Sedation Scale greater than or equal to “-3” were assessed for delirium excluding those with stroke, dementia, psychosis or persistent coma. The results were compared with the reference evaluation carried out by a psychiatrist using the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria. The inter-rater reliability was calculated using the kappa (κ) statistic. The CAM-ICU concurrent validity was assessed using Cronbach’s α coefficient, sensitivity, specificity as well as positive and negative predictive values (PPV and NPV, respectively) for the two Tunisian CAM-ICU raters.ResultsThe study involved 137 patients [median (IQR) age: 60 [49–68] years, male sex (n = 102), invasive mechanical ventilation (n = 49)]. Using the DSM-V criteria evaluations, 46 patients were diagnosed with delirium. When applying the Tunisian version of the CAM-ICU, 38(27.7%) patients were diagnosed with delirium for the first rater and 45(32.6%) patients for the second one. The Tunisian CAM-ICU showed a very-high inter-rater reliability for both intensivists (κ = 0.844, p < 0.001). Using the DSM-V rater as the reference standard, the sensitivity of the two intensivists’ evaluations was 80.4 vs. 95.7%. Specificity was 98.9% for both. The Cronbach’s α of the first and second raters’ evaluations using the Tunisian version of the CAM-ICU were 0.886 and 0.887, respectively.ConclusionsThe Tunisian version of the CAM-ICU showed almost perfect validity and reliability in detecting delirium in critically ill patients. It could therefore be used in Tunisian ICUs or where Tunisian translators are available following appropriate training.Trial registrationNot applicable.
Highlights
Delirium is common in critically ill patients and it is associated with poor outcomes
The Tunisian version of the CAM-intensive care unit (ICU) showed almost perfect validity and reliability in detecting delirium in critically ill patients. It could be used in Tunisian ICUs or where Tunisian translators are available following appropriate training
When delirium occurs in patients admitted to an intensive care unit (ICU), it can be associated with adverse outcomes such as selfextubation, catheter removal, difficulties of weaning, prolonged stay, higher mortality rates, and higher healthcare costs [4]
Summary
Delirium is common in critically ill patients and it is associated with poor outcomes. Delirium is an acute brain dysfunction characterized by fluctuating levels of disturbance in consciousness and cognition, impaired short term memory, disturbed attention and disorientation [1]. This serious problem can be detrimental to patients’ safety [2, 3]. According to the SCCM, the Confusion Assessment Method (CAM-ICU) and the Intensive Care Delirium Screening Checklist are the most valid and reliable tools for screening delirium in ICU patients [5, 11, 12]. The CAM-ICU is the most widely used tool for delirium assessment in ICUs [1]. It is based on the CAM designed for healthcare providers without a formal psychiatric training [13]
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