Standardization of the Czech Version of The Confusion Assessment Method for the Intensive Care Unit (CAM‑ICUcz)


Authors: A. Mitášová 1;  J. Bednařík 1;  M. Košťálová 1;  R. Michalčáková 1;  M. Ježková 1;  T. Kašpárek 2;  S. Skutilová 1;  E. Straževská 3;  P. Šályová 4;  V. Šikolová ;  L. Šrámková
Authors‘ workplace: Neurologická klinika LF MU a FN Brno 1;  Psychiatrická klinika LF MU a FN Brno 2;  Klinika anesteziologie, resuscitace a intenzivní medicíny LF MU a FN Brno 3;  LF MU 4
Published in: Cesk Slov Neurol N 2010; 73/106(3): 258-266
Category: Original Paper

Overview

Introduction:
The incidence of delirium in intensive care settings is reported as 62%, and in mechanically-ventilated patients it reaches 82%. Delirium is, however, underdiagnosed because of the non-use of standardised diagnostic tools; no such tool yet exists in the Czech language. The aim was to standardise a Czech version of the most frequently used standard test in the English language – the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Patients and method: A Czech version of CAM-ICU (CAM-ICUcz) was prepared by using a “forward-backward translation” method followed by acceptance on the part of the authors of the original test (http://www.icudelirium.org/docs/CAM_ICU_training_Czech.pdf). The assessment of CAM-ICUcz validity to detect delirium, compared with the expert assessment based on standard criteria for delirium of the Diagnostic and Statistical Manual of mental disorders (DSM IV), was performed in patients with: A. Acute cerebral stroke: n = 80; B. Mechanical ventilation: n = 10; C. Dementia: n = 34; D. Depression: n = 20; E. Schizophrenia: n = 22. Results: The expert assessment found an episode of delirium in 37 stroke patients (46.25%). The sensitivity and specificity of CAM-ICUcz were 97.3% and 93.0% respectively. All three patients with false positive for delirium due to CAM-ICUcz had severe aphasia of the global or Wernicke type. The test was performable even in mechanically ventilated patients, with delirium detected in 50% of patients and 100% concordance with the expert assessment. CAM-ICUcz was negative in all patients with dementia, depression and schizophrenia (specificity 100%). The test appeared to be quick (duration up to 10 minutes) and applicable by health care workers not specialised in neuropsychological testing in intensive care patients, including those mechanically ventilated. Conclusion: CAM-ICUcz is a suitable screening test for detection of delirium in the intensive care setting.

Key words:
delirium – intensive care – screening


Sources

1. Ely EW, Inouye S, Bernard G, 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– 2710.

2. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus B et al. Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM‑ICU). Crit Care Med 2001; 29(7):1370– 1379.

3. Sessler CN, Gosnell M, Grap MJ, Brophy GT, O‘Neal PV, Keane KA et al. The Richmond Agitation‑ Sedation Scale: validity and reliability in adult intensive care patients. Am J Respir Crit Care Med 2002; 166(10):1338– 1344.

4. Ely EW, Truman B, Shintani A, Thomason JWW, Wheeler AP, Gordon S et al. Monitoring sedation status over time in ICU patients: the reliability and validity of the Richmond Agitation Sedation Scale (RASS). JAMA 2003; 289(22): 2983– 2991.

5. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113(12): 941– 948.

6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association 2000.

7. International Statistical Classification of Diseases and Related Health Problems. 10th rev. 2nd ed. Geneva: WHO 2004. Oficiální český překlad je dostupný z URL: http:/ / www.uzis.cz/ cz/ mkn/ .

8. Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrooke’s Cognitive Examination Revised (ACE‑ R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry 2006; 21(11): 1078– 1085.

9. Hummelová‑ Fanfrdlová Z, Rektorová I, Sheardová K,Bartoš A, Línek V et al. Česká adaptace addenbrookského kognitivního testu. Cesk Psychol 2009; 53(4): 376– 388.

10. Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968; 114(512): 797– 811.

11. Kostálová M, Bártková E, Sajgalíková K, Dolenská A, Dusek L, Bednarík J. A standardization study of the Czech version of the Mississippi Aphasia Screening Test (MASTcz) in stroke patients and control subjects. Brain Injury 2008; 22(10): 793– 801.

12. Košťálová M, Bednařík J. Screening afázie: MASTcz. Dostupné z URL: http:/ / www.fnbrno.cz/ Article.asp?nDepartmentID=1355&nArticleID=2298&nLanguageID=1.

13. Bednařík J, Košťálová M, Sechovský H. CAM‑ICU: Czech version [cited 2009 Dec 21]. Dostupné z URL: http:/ / www.icudelirium.org/ docs/ CAM_ICU_training_Czech.pdf.

14. McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: Occurrence and clinical course in older patients. J Am Geriatr Soc 2003; 51(5): 591– 598.

15. Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291(14): 1753– 1762.

16. Milbrandt EB, Deppen S, Harrison PL, Shintani AK, Speroff T, Stiles RA et al: Costs associated with delirium in mechanically ventilated patients. Crit Care Med 2004; 32(4): 955– 962.

17. Franco K, Litaker D, Locala J, Bronson D. The cost of delirium in the surgical patient. Psychosomatics 2001; 42(1): 68– 73.

18. Caplan JP. Don’t ask, don’t tell: delirium in the intensive care unit. Crit Care Med 2009; 37(3): 1129– 1130.

19. Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med 2001; 27(5): 859– 864.

20. Plaschke K, von Haken R, Scholz M, Engelhardt R,Brobeil A, Martin E et al. Comparison of the confusion assessment method for the intensive care unit (CAM‑ICU) with the Intensive Care Delirium Screening Checklist (ICDSC) for delirium in critical care patients gives high agreement rate(s). Intensive Care Med 2008; 34(3): 431– 436.

21. Patel RP, Gambrell M, Speroff T, Scott T; Pun BT, Okahashi J et al. Delirium and sedation in the intensive care unit: Survey of behaviors and attitudes of 1384 healthcare professionals. Crit Care Med 2009; 37(3): 825– 832.

22. Ely EW, Stephens RK, Jackson JC, Thomason JW, Truman B, Gordon S et al. Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Crit Care Med 2004; 32(1): 106– 112.

23. Haluzová A, Bednařík J, Košťálová M, Michalčáková R, Voháňka S, Mitáš L. Delirium u pacientů s akutním iktem a u pacientů po operačním zákroku. Cesk Slov Neurol N 2008; 71/ 104 (Suppl 3): S60.

24. Haluzová A, Bednařík J, Košťálová M, Baďurová R, Voháňka S, Jura R. Delirium u pacientů s cévní mozkovou příhodu –  epidemiologie a rizikové faktory. Cesk Slov Neurol N 2008; 71/ 104 (Suppl 2): S64.

25. Adunsky A, Levy R, Heim M, Mizrahi E, Arad M. The unfavorable nature of preoperative delirium in elderly hip fractured patients. Arch Gerontol Geriatr 2003; 36(1): 67– 74.

26. Cséfalvay Z. Traubner P. Afaziológia pre klinickú prax. Martin: Osveta 1996.

27. Sarno MT, Levita E. Some observations on the nature of recovery in global aphasia after stroke. Brain Lang 1981; 13(1): 1– 12.

28. Kundrátová M. Metodika obnovovania reči při senzorickej afázii. Diplomová práca. Bratislava: PdF UK 1996.

29. Bednařík J. Neurologické poruchy v rámci kritického stavu. Cesk Slov Neurol N 2008; 71/ 104(5): 511– 529.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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