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

Česká verzia

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 place of work: 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 the journal: Cesk Slov Neurol N 2010; 73/106(3): 258-266
Category: Original Paper

Summary

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

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