The Confusion Assessment Method for Intensive Care Unit: A Large Cohort Validation Study in the Emergency Department of a Tertiary Hospital
DOI:
https://doi.org/10.24950/rspmi.682Keywords:
Delirium/diagnosis, ; Emergency Service Hospital, Intensive Care Units, Severity of Illness IndexAbstract
Introduction: The Confusion Assessment Method for Intensive Care Unit (CAM-ICU) is of great potential value in the emergency department (ED). However, there is still uncertainty about its diagnostic accuracy and reliability, with studies warranting larger cohorts. In one of the largest and most heterogeneous cohorts considered to date, the aim was to vali[1]date and explore the applicability of the CAM-ICU (European Portuguese) as a delirium screening and diagnostic tool in the ED setting of a main hospital referral centre.
Methods: Data were randomly and prospectively recorded in a convenience sample of patients with 18 years or older admitted to the ED of Hospital de Braga (Braga, Portugal). Delirium status was primarily assessed using the CAM- -ICU. For the validation aspect, the reference standard was a psychiatric evaluation, conducted within 3 hours of the CAM- -ICU by a psychiatrist blind to the finding, using the DSM-5 diagnostic criteria, without external interference on the regular proceedings in the ED on the timing, number and operationalization of psychiatric evaluations in the setting.
Results: After exclusion/inclusion criteria, of the 592 patients evaluated, 19.8% were diagnosed with delirium using the CAM-ICU. The reference standard was applied to 81 patients. The CAM-ICU presented a sensitivity of 95.2% (95% CI= 74.1 to 99.8) and specificity of 88.3% (95% CI= 76.8 to 94.8). CAM-ICU showed an accuracy of 90.1% with the reference standard.
Conclusion: The CAM-ICU (Portuguese version) is practical, valid and reliable instrument for the assessment of delirium in the real setting of an ED showing sensibility, specificity and accuracy for delirium diagnosis.
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