Validation of the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) Acuity Tool for Pediatric Critical Care Nursing

Background The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) acuity tool was developed to quantify patient acuity in terms of nursing cognitive workload complexity in a large, freestanding children's hospital in the United States. Objectives To describe the acuity and complexity of pediatric critical care nursing at a large children's hospital and correlate the CAMEO II with pediatric physiologic measures. Methods Construct validation was conducted correlating the CAMEO II to a pediatric classification system and 2 physiologic acuity tools. Descriptive statistics summarized patient characteristics. Construct validity across tools was evaluated using the Spearman correlation coefficient. Results CAMEO II was described both continuously and as ordinal complexity levels (I-V). Among 235 patients who completed CAMEO II across 4 intensive care units (ICUs), the mean total score was 99.06 (median, 97; range, 59-204). The CAMEO II complexity classification for 235 patients was as follows: I: 22 (9.4%), II: 53 (22.6%), III: 56 (23.8%), IV: 66 (28.1%), and V: 38 (16.2%). Findings from the 235 patients across the 4 ICUs revealed a significant correlation between the CAMEO II and the Therapeutic Intervention Scoring System-Children (rho = 0.567, P < .001), CAMEO II and Pediatric Risk of Mortality III (rho = 0.446, P < .001), and the CAMEO II and Score for Neonatal Acute Physiology Perinatal Extension II (rho = 0.359, P = .013). Discussion Utilization of CAMEO II across ICUs provides an opportunity to validate the current complexity of pediatric critical care nursing in a large children's hospital.