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The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies

Dimitri Gusmao-Flores12*, Jorge Ibrain Figueira Salluh34, Ricardo Ávila Chalhub2 and Lucas C Quarantini256

Author Affiliations

1 Intensive Care Unit, University Hospital Prof. Edgar Santos, Universidade Federal da Bahia, Rua Augusto Viana, Salvador, 40110-910, Brazil

2 Programa de Pós-graduação em Processos Interativos dos Órgãos e Sistemas, Instituto de Ciências da Saúde (ICS), Universidade Federal da Bahia, Av. Reitor Miguel Calmon, Salvador, 40110-902, Brazil

3 D'Or Institute of Research and Education, Rua Diniz Cordeiro, 30, Rio de Janeiro, 22281-100, Brazil

4 PostGraduate Program, Instituto Nacional do Câncer (INCA), Praça Cruz Vermelha, 23, Rio de Janeiro, 20230-130, Brazil

5 Department of Neurosciences and Mental Health, University Hospital Prof. Edgar Santos, Universidade Federal da Bahia, Rua Augusto Viana, Salvador, 40110-910, Brazil

6 Programa de Pós-graduação em Medicina e Saúde (PPgMS) - Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Rua Augusto Viana, Salvador, 40110-910, Brazil

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Critical Care 2012, 16:R115  doi:10.1186/cc11407

Published: 3 July 2012

Abstract

Introduction

Delirium is a frequent form of acute brain dysfunction in critically ill patients, and several detection tools for it have been developed for use in the Intensive Care Unit (ICU). The objective of this study is to evaluate the current evidence on the accuracy of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for the diagnosis of delirium in critically ill patients.

Methods

A systematic review was conducted to identify articles on the evaluation of the CAM-ICU and the ICDSC in ICU patients. A MEDLINE, SciELO, CINAHL and EMBASE databases search was performed for articles published in the English language, involving adult populations and comparing these diagnostic tools with the gold standard, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Results were summarized by meta-analysis. The QUADAS scale was used to assess the quality of the studies.

Results

Nine studies evaluating the CAM-ICU (including 969 patients) and four evaluating the ICDSC (n = 361 patients) were included in the final analysis. The pooled sensitivity of the CAM-ICU was 80.0% (95% confidence interval (CI): 77.1 to 82.6%), and the pooled specificity was 95.9% (95% CI: 94.8 to 96.8%). The diagnostic odds ratio was 103.2 (95% CI: 39.6 to 268.8). The pooled area under the summary receiver operating characteristic curve (AUC) was 0.97. The pooled sensitivity of the ICDSC was 74% (95% CI: 65.3 to 81.5%), and the pooled specificity was 81.9% (95% CI: 76.7 to 86.4%). The diagnostic odds ratio was 21.5 (95% CI: 8.51 to 54.4). The AUC was 0.89.

Conclusions

The CAM-ICU is an excellent diagnostic tool in critically ill ICU patients, whereas the ICDSC has moderate sensitivity and good specificity. The available data suggest that both CAM-ICU and the ICDSC can be used as a screening tool for the diagnosis of delirium in critically ill patients.