Validity And Reliability Of CAM-ICU Chinese Version And A Comparison With Other Instruments

OBJECTIVE To evaluate the reliability and validity of CAM-ICU revised Chineseversion in detecting early postoperative delirium in the PACU settings.METHODS With the permission of Prof. Wesley Ely, who is the author of originalCAM-ICU, we translated the scale into simplified Chinese version according to theguidelines of ISPOR,2005, and made some modification to meet the needs ofcross-cultural adaptation. Patients who received selective non-cardiac surgery undergeneral anesthesia and admitted in PACU were recruited. In phase1, we tested thevalidity with DSM-IV serving as a gold standard. In phase2, two researchersevaluated CAM-ICU simultaneously and recorded the score separately to test theinterrater reliability.RESLUTS In phase1, a total of374patients were included. Incidence of deliriumwas16.3%by DSM-IV and22.2%by CAM-ICU. Compared to the gold standard, the sensitivity of CAM-ICU was90.2%(95%CI79.1%~95.9%), the specificity was91.1%(95%CI87.2%~93.9%), the positive predictive value was66.3%(95%CI55.0%~76.0%), the negative predictive value was97.9%(95%CI95.3%~99.2%), andthe overall cross-validated kappa was0.71(P<0.01). In phase2, there were the65paired observations. The kappa statistics showed the interrater agreement of eachfeature was0.74,1.00,0.89, and0.80respectively (P<0.01); overall interraterreliability was very good (kappa statistics=0.91, P<0.01).CONCLUSION The revised Chinese version of CAM-ICU showed good validity andreliability in screening early postoperative delirium, and Arabic numbers was a goodsubstitution for letters in attention examination. OBJECTIVE To compare the validity of3commonly used delirium screening toolsCAM-ICU, ICDSC and Nu-DESC in the PACU settings.METHODS Patients who received selective non-cardiac surgery under generalanesthesia and admitted in PACU were recruited. Research assistant evaluated eachpatient by CAM-ICU, ICDSC and Nu-DESC successively. With DSM-IV serving as agold standard, compare the sensitivity and specificity of the3scales.RESULTS A total of330patients were included in this research. According to thediagnosis of DSM-IV, incidence of delirium was16.7%. Area under the ROC curve ofICDSC and Nu-DESC was0.97and0.98, respectively (P<0.01), and the cut-off of the2scales was5and3. Compared to gold standard, the sensitivity of CAM-ICU, ICDSC and Nu-DESC was90.9%、94.5%and94.5%, and there was no statisticalsignificance between each other; the specificity of the3instruments was91.6%、85.1%and90.5%, and ICDSC had a lower specificity when compared to CAM-ICUand Nu-DESC (P<0.01); the kappa statistic with the gold standard was0.73、0.62and0.73(P<0.01).CONCLUSION All of the3instruments showed good validity when used to assessdelirium in PACU setting, but ICDSC had a a lower specificity when compared toCAM-ICU and Nu-DESC.