Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for the Diagnosis of Delirium in Adults in Critical Care Settings
Cochrane Database of Systematic Reviews
Miranda, F., Gonzalez, F., et al. (2023).
Cochrane Database of Systematic Reviews, 11(11), Cd013126.
This systematic review and meta-analysis investigates the diagnostic accuracy of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for detecting delirium in adults in critical care settings. This review also explores the potential impact of various factors (e.g., patient characteristics, delirium type and severity, administrator) on test accuracy.
The Cochrane Collaboration; National Institute for Health Research (United Kingdom)
From databased inception to July 8, 2022
Published diagnostic studies excluding case-control studies
25
<div>Overall, the CAM-ICU had a pooled sensitivity of 0.78 and a pooled specificity of 0.95 for identifying delirium in adults in critical care settings. Additional findings included:</div>
<ul>
<li><span style="color: #333333;"><strong>DSM Criteria</strong>: </span><span style="color: #333333;">When using the DSM-V criteria for delirium, specificity improved (0.98), but sensitivity remained unchanged (0.75). </span></li>
<li><span style="color: #333333;"><strong>Mechanical Ventilation</strong>: In studies that solely included individuals with mechanical ventilation, sensitivity was 0.91 and specificity was 0.98. This diagnostic accuracy was improved, but not statistically different from studies incorporating both mechanically ventilated and non-ventilated patients (sensitivity = 0.81, specificity = 0.95). </span></li>
<li><span style="color: #333333;"><strong>Intensive Care Unit (ICU) Type</strong>: ICU type had no significant impact on diagnostic accuracy, with similar psychometrics on surgical ICU units (sensitivity = 0.74, specificity = 0.96) and non-surgical ICU units </span><span style="color: #333333;">(sensitivity = 0.79, specificity = 0.95).</span></li>
<li><span style="color: #333333;"><strong>Translated Versions</strong>: The use of translated versions of the CAM-ICU had no significant impact on test performance for individuals who speak languages other than English.</span></li>
</ul>
<div><span style="color: #333333;">There was insufficient information to determine the impact of test administrator or delirium subtype and severity on diagnostic accuracy of the CAM-ICU. The authors of this review note that the CAM-ICU may "miss a proportion of patients with incident delirium," and repeated administration of the CAM-ICU or combined testing with another assessment may be needed to identify all instances of delirium (p. 2). <br><br>Limitations to this review include the lack of reporting of specific details within studies (e.g., delirium subtype and severity, test administrator) and differences between studies regarding the administration protocols and gold standard comparators. </span></div>
