Delirium among critically ill adults: evaluation of the psychometric properties of the Italian 'Confusion Assessment Method for the Intensive Care Unit'

Abstract

Objectives: To determine the psychometric properties of the Italian version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), a clinical assessment tool to detect delirium among Intensive Care Unit patients.

Design: Validation study.

Research methodology: Fifty-seven patients admitted to three medical and surgical Intensive Care Units were recruited. During the study interval two trained examiners performed independent delirium assessment by the CAM-ICU for a maximum of four times per patient.

Main outcome measures: Interrater reliability and internal consistency of the tool, which were measured using Cohen's κ and Cronbach's α coefficients respectively.

Findings: Seventy-two paired evaluations were collected. The 35% of the studied cohort tested positive for delirium. The Italian version of the CAM-ICU demonstrated a substantial interrater reliability (κ=0.76, p<0.0001) and a very good internal consistency (α=0.87, 95% confidence interval: 0.81-0.91).

Conclusion: The Italian CAM-ICU was found to be a viable instrument by which to approach a standardised monitoring of delirium among Italian speaking ICU patients. The use of such tools may facilitate ICU physicians and nurses in detecting delirium, thus improving both quality and safety of care.

Keywords: Clinical assessment tools; Cognitive impairment; Critical care; Delirium; Intensive care units; Neurological monitoring.