PMID- 24673674
OWN - NLM
STAT- MEDLINE
DCOM- 20140916
LR  - 20211021
IS  - 1553-2712 (Electronic)
IS  - 1069-6563 (Print)
IS  - 1069-6563 (Linking)
VI  - 21
IP  - 2
DP  - 2014 Feb
TI  - Validation of the Confusion Assessment Method for the Intensive Care Unit in 
      older emergency department patients.
PG  - 180-7
LID - 10.1111/acem.12309 [doi]
AB  - OBJECTIVES: In the emergency department (ED), health care providers miss delirium 
      approximately 75% of the time, because they do not routinely screen for this 
      syndrome. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) 
      is a brief (<1 minute) delirium assessment that may be feasible for use in the 
      ED. The study objective was to determine its validity and reliability in older ED 
      patients. METHODS: In this prospective observational cohort study, patients aged 
      65 years or older were enrolled at an academic, tertiary care ED from July 2009 
      to February 2012. An emergency physician (EP) and research assistants (RAs) 
      performed the CAM-ICU. The reference standard for delirium was a comprehensive 
      (~30 minutes) psychiatrist assessment using the Diagnostic and Statistical Manual 
      of Mental Disorders, Fourth Edition, Text Revision criteria. All assessments were 
      blinded to each other and were conducted within 3 hours. Sensitivities, 
      specificities, and likelihood ratios were calculated for both the EP and the RAs 
      using the psychiatrist's assessment as the reference standard. Kappa values 
      between the EP and RAs were also calculated to measure reliability. RESULTS: Of 
      406 patients enrolled, 50 (12.3%) had delirium. The median age was 73.5 years old 
      (interquartile range [IQR] = 69 to 80 years), 202 (49.8%) were female, and 57 
      (14.0%) were nonwhite. The CAM-ICU's sensitivities were 72.0% (95% confidence 
      interval [CI] = 58.3% to 82.5%) and 68.0% (95% CI = 54.2% to 79.2%) in the EP and 
      RAs, respectively. The CAM-ICU's specificity was 98.6% (95% CI = 96.8% to 99.4%) 
      for both raters. The negative likelihood ratios (LR-) were 0.28 (95% CI = 0.18 to 
      0.44) and 0.32 (95% CI = 0.22 to 0.49) in the EP and RAs, respectively. The 
      positive likelihood ratios (LR+) were 51.3 (95% CI = 21.1 to 124.5) and 48.4 (95% 
      CI = 19.9 to 118.0), respectively. The kappa between the EP and RAs was 0.92 (95% 
      CI = 0.85 to 0.98), indicating excellent interobserver reliability. CONCLUSIONS: 
      In older ED patients, the CAM-ICU is highly specific, and a positive test is 
      nearly diagnostic for delirium when used by both the EP and RAs. However, the 
      CAM-ICU's sensitivity was modest, and a negative test decreased the likelihood of 
      delirium by a small amount. The consequences of a false-negative CAM-ICU are 
      unknown and deserve further study.
CI  - (c) 2014 by the Society for Academic Emergency Medicine.
FAU - Han, Jin H
AU  - Han JH
AD  - Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, 
      TN; Department of Emergency Medicine, Vanderbilt University School of Medicine, 
      Nashville, TN.
FAU - Wilson, Amanda
AU  - Wilson A
FAU - Graves, Amy J
AU  - Graves AJ
FAU - Shintani, Ayumi
AU  - Shintani A
FAU - Schnelle, John F
AU  - Schnelle JF
FAU - Dittus, Robert S
AU  - Dittus RS
FAU - Powers, James S
AU  - Powers JS
FAU - Vernon, John
AU  - Vernon J
FAU - Storrow, Alan B
AU  - Storrow AB
FAU - Ely, E Wesley
AU  - Ely EW
LA  - eng
GR  - UL1 TR000445/TR/NCATS NIH HHS/United States
GR  - K23AG032355/AG/NIA NIH HHS/United States
GR  - R01 AG035117/AG/NIA NIH HHS/United States
GR  - K12 HL109019/HL/NHLBI NIH HHS/United States
GR  - R01AG027472/AG/NIA NIH HHS/United States
GR  - R01 AG027472/AG/NIA NIH HHS/United States
GR  - UL1 RR024975/RR/NCRR NIH HHS/United States
GR  - K23 AG032355/AG/NIA NIH HHS/United States
GR  - UL1 RR024975-01/RR/NCRR NIH HHS/United States
GR  - 2 UL1 TR000445-06/TR/NCATS NIH HHS/United States
GR  - R01AG035117/AG/NIA NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PT  - Validation Study
PL  - United States
TA  - Acad Emerg Med
JT  - Academic emergency medicine : official journal of the Society for Academic 
      Emergency Medicine
JID - 9418450
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Confusion/diagnosis
MH  - Delirium/*diagnosis
MH  - *Emergency Service, Hospital
MH  - Female
MH  - Humans
MH  - Intensive Care Units
MH  - Likelihood Functions
MH  - Logistic Models
MH  - Male
MH  - Observer Variation
MH  - Prospective Studies
MH  - *Psychiatric Status Rating Scales
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
PMC - PMC4034173
MID - NIHMS545314
COIS- The authors have no potential conflicts of interest to disclose.
EDAT- 2014/03/29 06:00
MHDA- 2014/09/17 06:00
PMCR- 2015/02/01
CRDT- 2014/03/29 06:00
PHST- 2013/05/30 00:00 [received]
PHST- 2013/08/09 00:00 [revised]
PHST- 2013/08/22 00:00 [accepted]
PHST- 2014/03/29 06:00 [entrez]
PHST- 2014/03/29 06:00 [pubmed]
PHST- 2014/09/17 06:00 [medline]
PHST- 2015/02/01 00:00 [pmc-release]
AID - 10.1111/acem.12309 [doi]
PST - ppublish
SO  - Acad Emerg Med. 2014 Feb;21(2):180-7. doi: 10.1111/acem.12309.