This work was completed while Dr. McNicoll was a fellow in geriatric medicine at Yale University School of Medicine supported by a National Institute of Health T32 grant (5 T32 AG19134). This work was supported in part by grants from the National Institute on Aging (R01AG12551 and K24AG00949) and by in-kind support from the Claude D. Pepper Older Americans Independence Center (P30AG02134211). Dr. Inouye is a recipient of a Midcareer Award from the National Institute on Aging (K24AG00949) and a Donaghue Investigator Award from the Patrick and Catherine Weldon Donaghue Medical Research Foundation (DF98-105). Dr. Ely is a recipient of the AFAR Pharmacology in Aging Grant and the Paul Beeson Faculty Scholar Award from the American Federation for Aging Research/Hartford Foundation. He is a recipient of a K23 from the National Institute of Health (AG01023–01A1) and is a Geriatric Research and Education Clinical Center investigator. Dr. Pisani is a recipient of a Merck/AFAR Junior Investigator Award in Geriatric Clinical Pharmacology, the Franklin T. Williams Geriatric Development Initiative through The CHEST Foundation, ASP, Hartford Foundation, American Lung Association Clincal Research Grant, Yale PepperCenter Early Career Development Award (P30AG02134211), and a Yale Mentored Clinical Scholar Program (K12RR17594) Award.
Detection of Delirium in the Intensive Care Unit: Comparison of Confusion Assessment Method for the Intensive Care Unit with Confusion Assessment Method Ratings
Article first published online: 24 FEB 2005
Journal of the American Geriatrics Society
Volume 53, Issue 3, pages 495–500, March 2005
How to Cite
McNicoll, L., Pisani, M. A., Ely, E. W., Gifford, D. and Inouye, S. K. (2005), Detection of Delirium in the Intensive Care Unit: Comparison of Confusion Assessment Method for the Intensive Care Unit with Confusion Assessment Method Ratings. Journal of the American Geriatrics Society, 53: 495–500. doi: 10.1111/j.1532-5415.2005.53171.x
This study was presented in part at the 2002 Annual Scientific Meeting of the American Geriatrics Society.
- Issue published online: 24 FEB 2005
- Article first published online: 24 FEB 2005
- intensive care;
- delirium instruments;
Objectives: To compare the Confusion Assessment Method (CAM) and CAM for the Intensive Care Unit (CAM-ICU) methods for detecting delirium in alert, nonintubated older ICU patients.
Design: Comparison study.
Setting: Fourteen-bed medical ICU of an 800-bed university teaching hospital.
Participants: Twenty-two patients aged 65 and older admitted to the ICU.
Measurements: Two blinded, trained clinician-researchers who had undergone interrater reliability testing interviewed patients separately, usually within 10 minutes of each other (up to 120 minutes). Each researcher examined patients for the four key CAM criteria: acuteness, inattention, disorganized thinking, and altered level of consciousness. One researcher used the CAM method with the Mini-Mental State Examination and Digit Span; the other researcher used the CAM-ICU method with nonverbal cognitive and attention tasks.
Results: Rates of delirium were 68% according to CAM and 50% according CAM-ICU. Comparing the two methods, agreement was 82%, with a kappa of 0.64. Using the CAM as the reference standard, the CAM-ICU had a sensitivity of 73% (95% confidence interval (CI)=60–86) and specificity of 100% (95% CI=56–100). There were four false-negative ratings using the CAM-ICU. Reasons for disparate results were that the CAM used more-detailed cognitive testing that detected more deficits (3 patients) and the time elapsed (90 minutes) between ratings in one patient with markedly fluctuating symptoms.
Conclusion: CAM and CAM-ICU agreement was moderately high. Although the CAM-ICU is recommended for ICU patients because of its brevity and ease of use, the standard CAM method may detect more subtle cases of delirium in nonintubated, verbal ICU patients.