CoChat
Sign Up
Cited by 3,210Intensive Care Unit Cognitive DisordersNosocomial Infections in ICUClinical Nutrition and Gastroenterology

Delirium in Mechanically Ventilated Patients: Validity and Reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)

Open access
Ely, E. Wesley, Inouye, Sharon K., Bernard, Gordon R., Gordon, Sharon, Francis, Joseph, May, Lisa, Truman, Brenda, Speroff, Theodore +4 more·2001·JAMA
DOI 10.1001/jama.286.21.2703
Open this paper in CoChat — free account

Abstract

CONTEXT: Delirium is a common problem in the intensive care unit (ICU). Accurate diagnosis is limited by the difficulty of communicating with mechanically ventilated patients and by lack of a validated delirium instrument for use in the ICU. OBJECTIVES: To validate a delirium assessment instrument that uses standardized nonverbal assessments for mechanically ventilated patients and to determine the occurrence rate of delirium in such patients. DESIGN AND SETTING: Prospective cohort study testing the Confusion Assessment Method for ICU Patients (CAM-ICU) in the adult medical and coronary ICUs of a US university-based medical center. PARTICIPANTS: A total of 111 consecutive patients who were mechanically ventilated were enrolled from February 1, 2000, to July 15, 2000, of whom 96 (86.5%) were evaluable for the development of delirium and 15 (13.5%) were excluded because they remained comatose throughout the investigation. MAIN OUTCOME MEASURES: Occurrence rate of delirium and sensitivity, specificity, and interrater reliability of delirium assessments using the CAM-ICU, made daily by 2 critical care study nurses, compared with assessments by delirium experts using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. RESULTS: A total of 471 daily paired evaluations were completed. Compared with the reference standard for diagnosing delirium, 2 study nurses using the CAM-ICU had sensitivities of 100% and 93%, specificities of 98% and 100%, and high interrater reliability (kappa = 0.96; 95% confidence interval, 0.92-0.99). Interrater reliability measures across subgroup comparisons showed kappa values of 0.92 for those aged 65 years or older, 0.99 for those with suspected dementia, or 0.94 for those with Acute Physiology and Chronic Health Evaluation II scores at or above the median value of 23 (all P<.001). Comparing sensitivity and specificity between patient subgroups according to age, suspected dementia, or severity of illness showed no significant differences. The mean (SD) CAM-ICU administration time was 2 (1) minutes. Reference standard diagnoses of delirium, stupor, and coma occurred in 25.2%, 21.3%, and 28.5% of all observations, respectively. Delirium occurred in 80 (83.3%) patients during their ICU stay for a mean (SD) of 2.4 (1.6) days. Delirium was even present in 39.5% of alert or easily aroused patient observations by the reference standard and persisted in 10.4% of patients at hospital discharge. CONCLUSIONS: Delirium, a complication not currently monitored in the ICU setting, is extremely common in mechanically ventilated patients. The CAM-ICU appears to be rapid, valid, and reliable for diagnosing delirium in the ICU setting and may be a useful instrument for both clinical and research purposes.

Integrity signals

Registry

Crossref · 10.1001/jama.286.21.2703

Cites

90 of 90 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

We couldn’t retrieve this paper’s full text, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Delirium and agitation in critically ill patients are associated with increased morbidity and risk of mortality.

    “Behavioral disorders such as delirium and agitation in the critically ill occur with a high frequency, ranging from 15% to 80% of patients, and have been associated with increased morbidity and risk of mortality [7-13].”

    From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [9]

  • Delirium and agitation occur frequently in critically ill patients, with reported frequencies of 15% to 80%.

    “Behavioral disorders such as delirium and agitation in the critically ill occur with a high frequency, ranging from 15% to 80% of patients, and have been associated with increased morbidity and risk of mortality [7-13].”

    From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [9]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Ely, E. W., Inouye, S. K., Bernard, G. R., Gordon, S., Francis, J., May, L., Truman, B., Speroff, T., Gautam, S., Margolin, R., Hart, R. P., & Dittus, R.
Affiliations
Vanderbilt University Medical Center (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2001-12-05
Volume
286
Issue
21
Pages
2703
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.286.21.2703
OpenAlex
W2138141660
Cited by
3,210
References
90
Citations by year
2026: 213 · 2025: 219 · 2024: 198 · 2023: 200 · 2022: 194 · 2021: 208 · 2020: 186 · 2019: 179 · 2018: 162 · 2017: 150 · 2016: 142 · 2015: 126 · 2014: 128 · 2013: 140 · 2012: 142
FWCI
19.53
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Intellectum (Universidad de La Sabana) (submittedVersion, cc-by-nc-nd)
Funders
National Institute on Aging (K24 AG00949, K23 AG01203-01A1, K24AG000949, R01AG012551, R01AG12551)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Keywords
delirium, mechanical ventilation, CAM-ICU, nonverbal assessment, intensive care unit, inter-rater reliability, sensitivity and specificity, delirium prevalence, dementia, critical care nursing
MeSH terms
Aged, Delirium, Female, Humans, Intensive Care Units, Male, Middle Aged, Prospective Studies, Reference Standards, Respiration, Artificial, Sensitivity and Specificity, Severity of Illness Index, Reproducibility of Results, Critical Illness, APACHE

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review