Validity and Predictability of the Confusion Assessment Method for the Intensive Care Unit for Delirium Among Critically Ill Patients in the Intensive Care Unit: A Systematic Review and Meta-Analysis
Nursing in Critical Care
Zhang, Y., Diao, D., et al. (2023).
Nursing in Critical Care, Advance online publication. https://doi.org/10.1111/nicc.12982.
<div>This systematic review with meta-analysis investigates the diagnostic accuracy of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for detecting delirium in critically ill ICU patients, 18 years and older. Of note, although speech-language pathologists (SLPs) do not diagnose delirium, SLPs may administer delirium screening tools as part of a multidisciplinary effort to prevent and manage delirium.</div>
Sichuan Science and Technology Program (China)
From database inception to December 31, 2022
<div>Cohort and cross-sectional designs</div>
29
<div>This review found the CAM-ICU to be a valid and reliable tool for predicting delirium in critically ill adults in the ICU. Meta-analysis revealed the following psychometric properties for the CAMI-ICU:</div>
<ul>
<li><span style="color: #333333;"><strong>pooled sensitivity</strong> = 82%;</span></li>
<li><span style="color: #333333;"><strong>pooled specificity</strong> = 95%; </span></li>
<li><span style="color: #333333;"><strong>area under the curve</strong> = 0.96; </span></li>
<li><span style="color: #333333;"><strong>positive likelihood ratio</strong> = 17; </span></li>
<li><span style="color: #333333;"><strong>negative likelihood ratio</strong> = 0.19; </span></li>
<li><span style="color: #333333;"><strong>positive predictive value</strong> = 94%; and </span></li>
<li><span style="color: #333333;"><strong>negative predictive value</strong> = 16%. </span></li>
</ul>
<div><span style="color: #333333;">Subgroup analysis revealed a higher sensitivity in Asian individuals (87%) than in non-Asian individuals (78%), however, specificity was equal between groups (95%). <br><br>When compared to the 4 ‘A’s (Arousal, Attention, Abbreviated Mental Test – 4, Acute change) Test (4AT), the CAM-ICU demonstrated higher specificity and lower sensitivity (specificity = 95% versus 88%-94%; sensitivity = 82% versus 76%-88%). <br><br>Limitations of this review include a lack of comparison between the CAM-ICU and other delirium assessment tools and limited reporting of population characteristics (e.g., delirium type and severity, presence of mechanical ventilation). Future research should determine the diagnostic accuracy of combined assessments and investigate the impact on patient characteristics on test outcomes, particularly in patients with long-term hospitalization.</span></div>
