Delirium assessment using Confusion Assessment Method for the Intensive Care Unit in Chinese critically ill patients

Purpose: The aim of this study was to provide a method for delirium evaluation in simplified Chinese for patients speaking this language via validation of a translation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Materials and Methods: Two phases were conducted including initial reliability testing (phase I) of the Attention Screening Exam (ASE) followed by reliability and validity testing of the CAM-ICU (phase II). To analyze the reliability of the ASE, each patient was assessed sequentially by ASE Visual and ASE Auditory. The patients were assessed by 2 nurse investigators using CAM-ICU and 1 neurologist using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition separately within 2 hours in the second phase. Results: We found that the agreement between ASE Visual and ASE Auditory was high (kappa = 0.83, P < .01, respectively). The educational level of the patients influenced the results of the inattention assessment, with the lower educational level of the patient yielding lower agreement on ASE. Even still, the kappa consistencies were all above 0.61. The sensitivities of CAM-ICU were 91.8% and 93.4%, and the specificities were 90.8%and 87.7%, respectively. The interrater reliability of 2 nurse investigators was very high, with kappa coefficient of 0.92 ( P < .001). Conclusions: This study affirmed the validity and reliability against reference raters using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition of a brief nursing-conducted method of diagnosing delirium in ICU patients who speak simplified Chinese using the CAM-ICU. (c) 2013 Elsevier Inc. All rights reserved.