Translation and validation of the Korean confusion assessment method for the intensive care unit
Eun Young HeoByoung-Jo LeeBong‐Jin HahmEun Hee SongHan-A LeeChul‐Gyu YooYoung Whan KimSung Koo HanYoung‐Soo ShimSang‐Min Lee
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Abstract:
Delirium is a common problem and associated with poor outcomes in intensive care unit (ICU) patients. Diagnosis of delirium in ICU patients is limited and usually underdiagnosed by physicians. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is one of the most widely used screening methods for detection of ICU delirium. Our goal was to translate and validate the CAM-ICU for use in the Korean ICU setting.Translation of the CAM-ICU was done according to the guidelines suggested by the Translation and Cultural Adaptation Group. For validation and interrater reliability assessment of the Korean CAM-ICU, two nurses independently assessed delirium in ICU patients and the results were compared with the reference evaluation, which was done by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV).Twenty-two patients were evaluated by two nurses and one psychiatrist expert independently. During the study period, we have continuously educated study nurses. Based on DSM-IV criteria, 16 out of 22 (72.7%) patients developed delirium. The sensitivities of the two nurses' evaluations using the Korean CAM-ICU were 89.80% for nurse 1 and 77.40% for nurse 2. Their specificities were 72.40% and 75.80% and their overall accuracy was 83.33% and 88.37% respectively. The Korean CAM-ICU was done with reasonable interrater reliability between nurse 1 and nurse 2 (κ = 0.81, p < 0.001).The Korean CAM-ICU showed good validity and could be incorporated into clinical practice in Korean ICUs.ISRCTN: ISRCTN50265663.Keywords:
Inter-Rater Reliability
Confusion
Delirium is frequently observed in intensive care unit patients and its occurrence is related to increased morbidity and mortality, length of stay, functional decline and high costs. The Confusion Assessment Method for Intensive Care Unit is a tool that facilitates early identification and occurrence of delirium among intubated patients.To verify the aspects of delirium studied by means of the Confusion Assessment Method for Intensive Care Unit. A literature review was conducted in the LILACS, MedLine, PubMed and CINAHL databases, from 2001, when the Confusion Assessment Method for Intensive Care Unit was validated, to 2008. Descriptors used for LILACS, MedLine and PubMed were delirium and intensive care unit, while for the CINAHL database, delirium and intensive care were used. From 293 articles, 35 were selected. The aspects analyzed disclosed, different types of delirium in different intensive care units. Variation in sensitivity was of 93% to 100% and variation in specificity, 89% to 100% of the Confusion Assessment Method for Intensive Care Unit, an important tool for detection, characterization and control of delirium and its impact. The aspects of delirium studied by means of the Confusion Assessment Method for Intensive Care Unit were: the performance index, identification, management, cost of treatment, morbidity and mortality due to delirium.
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Delirium is a common condition in the intensive care unit (ICU). Between 16-89% of all ICU patients experience an episode of delirium during admission. Several detection tools have been developed for use specifically in the ICU. The Confusion Assessment Method for the intensive care unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) combine high sensitivity with high specificity. Treatment consists of treatment of underlying disorders, nonpharmacological measures and symptomatic drug therapy. The prognosis for ICU patients who experience delirium is worse than for those who do not. Delirious patients are more likely to develop complications, spend longer in hospital and have a higher mortality rate. In view of the high frequency, poor prognosis, high costs and lack of studies into the treatment of ICU delirium, research into the possibilities for prevention, early detection and treatment of the condition is essential.
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Delirium is a serious complication of disorders of nervous system and requires early detection for successful treatment. Confusion assessment method for intensive care unit (CAM-ICU) is a fast and reliable tool for detection of delirium. We performed screening for delirium among patients of neurological ward using CAM-ICU. Our experience showed that CAM-ICU could be used for the identification of delirium in neurological patients excluding those who suffer from severe aphasia.
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Intensive care psychosis, intensive care unit syndrome, acute confusional state and acute brain dysfunction are all delirium, a manifestation of acute brain failure associated with serious adverse outcomes. Most intensive care delirium is hypoactive and undetected. Screening for and managing delirium could significantly improve outcomes.
Acute care
Organic mental disorders
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Delirium (acute confusion) is a common condition among older patients that often goes unrecognized. Although there are many delirium screening tools, the Confusion Assessment Method (CAM) appears to be the best tool to use at the bedside. Given its association with morbidity and mortality, prevention of delirium is crucial. Multi-component preventative strategies have been found to be effective. Once delirium occurs, similar multicomponent strategies can be incorporated into the management strategy. Precipitating factors should also be addressed. There is insufficient evidence to support the use of pharmacological agents for either the prevention or management of delirium.
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Delirium is a serious complication that commonly occurs in critically ill patients in the intensive care unit (ICU). Delirium is frequently unrecognized or missed despite its high incidence and prevalence, and leads to poor clinical outcomes and an increased cost by increasing morbidity, mortality, and hospital and ICU length of stay. Although its pathophysiology is poorly understood, numerous risk factors for delirium have been suggested. To improve clinical outcomes, it is crucial to perform preventive measures against delirium, to detect delirium early using valid and reliable screening tools, and to treat the underlying causes or hazard symptoms of delirium in a timely manner. Keywords: Delirium; Intensive care unit; Outcome.
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Background Delirium is a common occurrence for patients in the intensive care unit and can have a profound and lasting impact on them. Few studies describe the experience of intensive care patients who have had delirium. Objective To understand the lived experience of intensive care for critically ill patients who experienced delirium. Methods The study participants consisted of 7 men and 3 women, 46 to 70 years old, who had delirium according to the Confusion Assessment Method for the Intensive Care Unit. The van Manen method of hermeneutic phenomenology was used, and data collection entailed audio recorded semistructured interviews. Results Four themes were detected: “I can’t remember,” “Wanting to make a connection,” “Trying to get it straight,” and “Fear and safety concerns.” Conclusion Nurses working in intensive care units need to assess patients for delirium, assess the mental status of patients who have delirium, and help patients and patients’ families learn about and deal with the psychological effects of the intensive care unit experience.
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