Journal of Korean Critical Care Nursing (중환자간호학회지)

Korean Society of Critical Care Nursing (한국중환자간호학회)
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Comparing the Validity of CAM-ICU and CAM-ICU-7 for Delirium Assessment based on Simulation

섬망 평가를 위한 CAM-ICU와 CAM-ICU-7 도구의 타당도 비교: 시뮬레이션 기반 연구

  • Received : 2024.08.19
  • Accepted : 2024.10.15
  • Published : 2024.10.31
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Abstract

Purpose : This study aimed to compare the validity and user evaluations of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and its 7-item version (CAM-ICU-7) for delirium assessment. Methods : Thirty-six intensive care unit (ICU) nurses from four university hospitals participated in this simulation-based methodological study. Four standardized patients with normal cognition, subsyndromal delirium, hypoactive delirium, and hyperactive delirium were recruited. The participants assessed all four standardized patients using the CAM-ICU and CAM-ICU-7. We analyzed the validity, assessment time, and user evaluations of both tools. DeLong's test and the paired t-test were used for comparisons. Results : The CAM-ICU showed sensitivity, specificity, and accuracy of 80.6%, 94.4%, and 84.0%, respectively, with an Area Under Curve (AUC) of 87.5%. CAM-ICU-7 demonstrated a sensitivity, specificity, and accuracy of 90.7%, 97.2%, and 92.4%, respectively, with an AUC of 94.0%. The CAM-ICU-7 showed a better AUC than the CAM-ICU for detecting subsyndromal delirium (p =.029). However, the CAM-ICU-7 required more time for assessment across all patient types (p <.001). ICU nurses reported that the CAM-ICU was faster to administer, whereas the CAM-ICU-7 was easier to use, better at detecting delirium, more effective at reflecting changes in delirium, and had a higher intention to use in clinical practice. Conclusion : The CAM-ICU-7 demonstrated superior validity compared to the CAM-ICU. Despite requiring more time, ICU nurses evaluated the CAM-ICU-7 as more useful. These findings support using the CAM-ICU-7 for delirium assessment in ICU settings.

Keywords

Acknowledgement

This research was funded by a grant from the National Research Foundation of Korea (NRF), supported by the Korean government (MSIT) (No. 2022R1A2C1011917), along with funding from the Korean Society of Critical Care Nursing.

References

  1. Keenan CR, Jain S. Delirium. Medical Clinics of North America. 2022;106(3):459-69. https://doi.org/10.1016/j.mcna.2021.12.003 
  2. Hosker C, Ward D. Hypoactive delirium. BMJ. 2017;357:j2047. https://doi.org/10.1136/bmj.j2047 
  3. Zhang M, Zhang X, Gao L, Yue J, Jiang X. Incidence, predictors and health outcomes of delirium in very old hospitalized patients: a prospective cohort study. BMC Geriatrics. 2022;22:262. https://doi.org/10.1186/s12877-022-02932-9 
  4. Devlin JW, Fong JJ, Fraser GL, Riker RR. Delirium assessment in the critically ill. Intensive Care Medicine. 2007;33:929-40. https://doi.org/10.1007/s00134-007-0603-5 
  5. Devlin JW, Skrobik Y, Gelinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine. 2018;46(9):e825-73. https://doi.org/10.1097/CCM.0000000000003299 
  6. Kang J, Choi MJ. A systematic review and meta-analysis on the effect of delirium prevention intervention in Korean intensive care units. Journal of Korean Critical Care Nursing. 2021;14(3):141-56. https://doi.org/10.34250/jkccn.2021.14.3.141 
  7. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: Validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA. 2001;286(21):2703-10. https://doi.org/10.1001/jama.286.21.2703 
  8. Heo EY, Lee BJ, Hahm BJ, Song EH, Lee HA, Yoo CG, et al. Translation and validation of the Korean confusion assessment method for the intensive care unit. BMC Psychiatry. 2011;11:94. https://doi.org/10.1186/1471-244X-11-94 
  9. Dos Santos FCM, Rego AS, Montenegro WS, de Carvalho STRF, Cutrim RC, Junior AAM, et al. Delirium in the intensive care unit: identifying difficulties in applying the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). BMC Nursing. 2022;21(1):323. https://doi.org/10.1186/s12912-022-01103-w 
  10. Serafim RB, Soares M, Bozza FA, Lapa E Silva JR, Dal-Pizzol F, Paulino MC, et al. Outcomes of subsyndromal delirium in ICU: a systematic review and meta-analysis. Critical Care. 2017;21179. https://doi.org/10.1186/s13054-017-1765-3 
  11. Serafim RB, Dal-Pizzol F, Souza-Dantas V, Soares M, Bozza FA, Povoa P, et al. Impact of subsyndromal delirium occurrence and its trajectory during ICU stay. Journal of Clinical Medicine. 2022;11(22):67-97. https://doi.org/10.3390/jcm11226797 
  12. Nielsen AH, Larsen LK, Collet MO, Lehmkuhl L, Bekker C, Jensen JF, et al. Intensive care unit nurses' perception of three different methods for delirium screening: A survey (DELIS-3). Australian Critical Care. 2023;36(6):1035-42. https://doi.org/10.1016/j.aucc.2022.12.008 
  13. Jones RN, Cizginer S, Pavlech L, Albuquerque A, Daiello LA, Dharmarajan K, et al. Assessment of instruments for measurement of delirium severity: A systematic review. JAMA Internal Medicine. 2019;179(2):231-9. https://doi.org/10.1001/jamainternmed.2018.6975 
  14. Khan BA, Perkins AJ, Gao S, Hui SL, Campbell NL, Farber MO, et al. The Confusion Assessment Method for the ICU-7 delirium severity scale: A novel delirium severity instrument for use in the ICU. Critical Care Medicine. 2017;45(5):851-7. https://doi.org/10.1097/CCM.0000000000002368 
  15. Collet MO, Nielsen AH, Larsen LK, Laerkner E, Jensen JF, Mortensen CB, et al. Delirium and delirium severity screening in the intensive care-correspondence of screenings tools. Australian Critical Care. 2024;37(3):407-13. https://doi.org/10.1016/j.aucc.2023.05.007 
  16. den Boogaard MV, Leenders M, Pop-Purceleanu M, Tilburgs B. Performance and validation of two ICU delirium assessment and severity tools; a prospective observational study. Intensive and Critical Care Nursing. 2024;83:103627. https://doi.org/10.1016/j.iccn.2024.103627 
  17. Ahmed I, Ishtiaq S. Reliability and validity: Importance in medical research. The Journal of the Pakistan Medical Association. 2021;71(10):2401-6. https://doi.org/10.47391/JPMA.06-861 
  18. Ho MH, Yu LF, Lin PH, Chang HR, Traynor V, Huang WC, et al. Effects of a simulation-based education programme on delirium care for critical care nurses: A randomized controlled trial. Journal of Advanced Nursing. 2021;77(8):3483-93. https://doi.org/10.1111/jan.14938 
  19. Helfand BKI, Tommet D, Detroyer E, Milisen K, Adamis D, Metzger ED, et al. Delirium item bank: Utilization to evaluate and create delirium instruments. Dementia and Geriatric Cognitive Disorders. 2022;51(2):110-9. https://doi.org/10.1159/000522522 
  20. Kresevic D, Heath B, Fine-Smilovich E, Jennings A, Carter J, Chen P, et al. Simulation training, coaching, and cue cards improve delirium care. Federal Practitioner. 2016;33(12):22-8. 
  21. Dale-Tam J, Posner GD. Alice's delirium: A theatre-based simulation scenario for nursing. Cureus. 2018;10(4):e2411. https://doi.org/10.7759/cureus.2411 
  22. Brummel NE, Boehm LM, Girard TD, Pandharipande PP, Jackson JC, Hughes CG, et al. Subsyndromal delirium and institutionalization among patients with critical illness. American Journal of Critical Care. 2017;26(6):447-55. https://doi.org/10.4037/ajcc2017263 
  23. Ho MH, Montgomery A, Traynor V, Chang CC, Kuo KN, Chang HR, et al. Diagnostic performance of delirium assessment tools in critically ill patients: A systematic review and meta-analysis. Worldviews on Evidence-Based Nursing. 2020;17(4):301-10. https://doi.org/10.1111/wvn.12462 
  24. Zhang Y, Diao D, Zhang H, Gao Y. Validity and predictability of the confusion assessment method for the intensive care unit for delirium among critically ill patients in the intensive care unit: A systematic review and meta-analysis. Nursing Critical Care. 2023. https://doi.org/10.1111/nicc.12982 
  25. Monaghan TF, Rahman SN, Agudelo CW, Wein AJ, Lazar JM, Everaert K, et al. Foundational statistical principles in medical research: Sensitivity, specificity, positive predictive value, and negative predictive value. Medicina. 2021;57(5):503. https://doi.org/10.3390/medicina57050503 
  26. Trevethan R. Sensitivity, specificity, and predictive values: Foundations, pliabilities, and pitfalls in research and practice. Frontiers in Public Health. 2017;5:307. https://doi.org/10.3389/fpubh.2017.00307 
  27. Plante E, Vance R. Selection of preschool language tests: A data-based approach. Language, Speech and Hearing Services in Schools. 1994;25(1):15-24. https://doi.org/10.1044/0161-1461.2501.15 
  28. Simundic AM. Measures of diagnostic accuracy: Basic definitions. The Journal of the International Federation of Clinical Chemistry and Laboratory Medicine. 2009;19(4):203-11. 
  29. Paulino MC, Conceicao C, Silvestre J, Lopes MI, Goncalves H, Dias CC, et al. Subsyndromal delirium in critically Ill patients-cognitive and functional long-term outcomes. Journal of Clinical Medicine. 2023;12(19):6363. https://doi.org/10.3390/jcm12196363 
  30. Krewulak KD, Rosgen BK, Ely EW, Stelfox HT, Fiest KM. The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients. PLoS One. 2020;15(11):e0242378. https://doi.org/10.1371/journal.pone.0242378 
  31. Seo Y, Lee HJ, Ha EJ, Ha TS. 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit. Acute and Critical Care. 2022;37(1):1-25. https://doi.org/10.4266/acc.2022.00094 
  32. Davis D, Searle SD, Tsui A. The Scottish Intercollegiate Guidelines Network: Risk reduction and management of delirium. Age and Ageing. 2019;48(4):485-8. https://doi.org/10.1093/ageing/afz036 
  33. Dos Santos FCM, Rego AS, Montenegro WS, de Carvalho STRF, Cutrim RC, Junior AAM, et al. Delirium in the intensive care unit: identifying difficulties in applying the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). BMC Nursing. 2022;21(1):323. https://doi.org/10.1186/s12912-022-01103-w 
  34. Riekerk B, Pen EJ, Hofhuis JG, Rommes JH, Schultz MJ, Spronk PE. Limitations and practicalities of CAM-ICU implementation, a delirium scoring system, in a Dutch intensive care unit. Intensive and Critical Care Nursing. 2009;25(5):242-9. https://doi.org/10.1016/j.iccn.2009.04.001