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Delirium in the intensive care setting: A reevaluation of the validity of the CAM–ICU and ICDSC versus the DSM–IV–TR in determining a diagnosis of delirium as part of the daily clinical routine

Published online by Cambridge University Press:  08 February 2017

Soenke Boettger ,
David Garcia Nuñez ,
Rafael Meyer ,
André Richter ,
Susana Franco Fernandez ,
Alain Rudiger ,
Maria Schubert  and
Josef Jenewein
Soenke Boettger*
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
David Garcia Nuñez
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital of Zurich, University of Zurich, Zurich, Switzerland University Hospital Basel, University of Basel, Basel, Switzerland
Rafael Meyer
Affiliation:
Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
André Richter
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
Susana Franco Fernandez
Affiliation:
Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Alain Rudiger
Affiliation:
Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Maria Schubert
Affiliation:
Inselspital, University Hospital of Bern, Directorate of Nursing/MTT, Bern, Switzerland
Josef Jenewein
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
*
Address correspondence and reprint requests to: Soenke Boettger, Department of Psychiatry and Psychotherapy, University Hospital of Zurich, University of Zurich, Ramistraase 100, 8091 Zurich, Switzerland. E-mail: soenke.boettger@usz.ch.
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Abstract

Background:

In the intensive care setting, delirium is a common occurrence that comes with subsequent adversities. Therefore, several instruments have been developed to screen for and detect delirium. Their validity and psychometric properties, however, remain controversial.

Method:

In this prospective cohort study, the Confusion Assessment Method for the Intensive Care Unit (CAM–ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) were evaluated versus the DSM–IV–TR in the diagnosis of delirium with respect to their validity and psychometric properties.

Results:

Out of some 289 patients, 210 with matching CAM–ICU, ICDSC, and DSM–IV–TR diagnoses were included. Between the scales, the prevalence of delirium ranged from 23.3% with the CAM–ICU, to 30.5% with the ICDSC, to 43.8% with the DSM–IV–TR criteria. The CAM–ICU showed only moderate concurrent validity (Cohen's κ = 0.44) and sensitivity (50%), but high specificity (95%). The ICDSC also reached moderate agreement (Cohen's κ = 0.60) and sensitivity (63%) while being very specific (95%). Between the CAM–ICU and the ICDSC, the concurrent validity was again only moderate (Cohen's κ = 0.56); however, the ICDSC yielded higher sensitivity and specificity (78 and 83%, respectively).

Significance of Results:

In the daily clinical routine, neither the CAM–ICU nor the ICDSC, common tools used in screening and detecting delirium in the intensive care setting, reached sufficient concurrent validity; nor did they outperform the DSM–IV–TR diagnostic criteria with respect to sensitivity or positive prediction, but they were very specific. Thus, the non-prediction by the CAM–ICU or ICDSC did not refute the presence of delirium. Between the CAM–ICU and ICDSC, the ICDSC proved to be the more accurate instrument.

Keywords

DeliriumIntensive care unitConfusion Assessment Method for Intensive Care Units (CAM–ICU)Intensive Care Delirium Screening Checklist (ICDSC)DSM–IV–TRConcurrent validity
Type
Original Articles
Information
Palliative & Supportive Care , Volume 15 , Issue 6 , December 2017 , pp. 675 - 683
Copyright
Copyright © Cambridge University Press 2017 

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Footnotes

*

Shared first authorship.

References

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