Psychometric properties of the Arabic version of the confusion assessment method for the intensive care unit (CAM-ICU)

Maha H Aljuaid,Maamoun Dbsawy,Daniah Alsayegh,Yaseen M Arabi,Moteb Alotaibi,Ahmad M Deeb

doi:10.1186/s12888-018-1676-0

Abstract

BackgroundIt is recommended that critically ill patients undergo routine delirium monitoring with a valid and reliable tool such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). However, the validity and reliability of the Arabic version of the CAM-ICU has not been investigated. Here, we test the validity and reliability of the Arabic CAM-ICU.MethodsWe conducted a psychometric study at ICUs in a tertiary-care hospital in Saudi Arabia. We recruited consecutive adult Arabic-speaking patients, who had stayed in the ICU for at least 24 hours, and had a Richmond Agitation-Sedation Scale (RASS) score ≥ − 2 at examination. Two well-trained examiners (ICU nurse and intensivist) independently assessed delirium in eligible patients with the Arabic CAM-ICU. Evaluations by the two examiners were compared with psychiatrist blind clinical assessment of delirium according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Subgroup analyses were conducted for age, invasive mechanical ventilation, and gender.ResultsWe included 108 patients (mean age: 62.6 ± 17.6; male: 51.9%), of whom 37% were on invasive mechanical ventilation. Delirium was diagnosed in 63% of enrolled patients as per the psychiatrist clinical assessment. The Arabic CAM-ICU sensitivity was 74% (95% confidence interval [CI] = 0.63–0.84) and 56% (95%CI = 0.44–0.68) for the ICU nurse and intensivist, respectively. Specificity was 98% (95%CI = 0.93–1.0) and 92% (95%CI = 0.84–1.0), respectively. Sensitivity was greater for mechanically-ventilated patients, women, and those aged ≥65 years. Specificity was greater for those aged < 65 years, non-mechanically-ventilated patients and men. The median duration to complete the Arabic CAM-ICU was 2 min (interquartile range, 2–3) and 4.5 min (IQR, 3–5) for the ICU nurse and intensivist, respectively. Inter-rater reliability (kappa) was 0.66.ConclusionsThe Arabic CAM-ICU demonstrated acceptable reliability and validity to assess delirium in Arabic-speaking ICU patients.

Highlights

It is recommended that critically ill patients undergo routine delirium monitoring with a valid and reliable tool such as the Confusion Assessment Method for the Intensive Care Unit (CAM-intensive care unit (ICU))
17 patients were excluded from the study analysis for the following reasons: duration of assessments between examiners exceeded the allowed 4 hours (n = 13); diagnosis of chronic schizophrenia (n = 1); diagnosis with drug addiction (n = 1); psychiatrist clinical assessment of delirium not completed (n = 1); and psychiatrist clinical assessment of delirium missing (n = 1)
With the psychiatrist clinical assessment, delirium was diagnosed in 68 patients (63%)

Summary

Introduction

It is recommended that critically ill patients undergo routine delirium monitoring with a valid and reliable tool such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). The validity and reliability of the Arabic version of the CAM-ICU has not been investigated. We test the validity and reliability of the Arabic CAM-ICU. Delirium is extremely common in critically ill patients, resulting from the acute illness, comorbidities, and use of sedation and analgesia. Delirium is influenced by environmental and physical factors in intensive care unit (ICU) settings, such as isolation, limited visiting hours, the use of restraint, and connection to multiple tubes, lines, and catheters [2,3,4,5]. Delirium is associated with increased morbidity and mortality, [11, 15, 16] and increased cognitive and functional deficits after hospital discharge [17, 18]

Methods

Results

Conclusion