Translation and validation of the Korean confusion assessment method for the intensive care unit

Abstract

BackgroundDelirium is a common problem and associated with poor outcomes in intensive care unit (ICU) patients. Diagnosis of delirium in ICU patients is limited and usually underdiagnosed by physicians. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is one of the most widely used screening methods for detection of ICU delirium. Our goal was to translate and validate the CAM-ICU for use in the Korean ICU setting.MethodsTranslation of the CAM-ICU was done according to the guidelines suggested by the Translation and Cultural Adaptation Group. For validation and interrater reliability assessment of the Korean CAM-ICU, two nurses independently assessed delirium in ICU patients and the results were compared with the reference evaluation, which was done by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV).ResultsTwenty-two patients were evaluated by two nurses and one psychiatrist expert independently. During the study period, we have continuously educated study nurses. Based on DSM-IV criteria, 16 out of 22 (72.7%) patients developed delirium. The sensitivities of the two nurses' evaluations using the Korean CAM-ICU were 89.80% for nurse 1 and 77.40% for nurse 2. Their specificities were 72.40% and 75.80% and their overall accuracy was 83.33% and 88.37% respectively. The Korean CAM-ICU was done with reasonable interrater reliability between nurse 1 and nurse 2 (κ = 0.81, p < 0.001).ConclusionsThe Korean CAM-ICU showed good validity and could be incorporated into clinical practice in Korean ICUs.Trial registrationISRCTN: ISRCTN50265663

Reliability and validity assessment of the Japanese version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)

“…Other language versions (original English, Spanish, Korean, and Greek versions) have yielded similar results (Adamis et al, 2012;Ely et al, 2001b;Heo et al, 2011;Tobar et al, 2010). This shows that the CAM-ICU evaluation training was effective.…”

“…With respect to Feature 2, we found a high degree of agreement (Ä = 0.90), which was superior to that witnessed in other language versions (Adamis et al, 2012;Heo et al, 2011). This shows that the Japanese version's use of numbers rather than the audio attention screening test (ASE) using the alphabet that is included in the all other language versions may be distinctly advantageous in terms of reliability.…”

“…In most previous CAM-ICU validation studies, the sedation ranges were not clearly described (Adamis et al, 2012;Ely et al, 2001b;Heo et al, 2011;Tobar et al, 2010), but they were assumingly heavier than what is allowed for by the current standard practice. Considering the similarity of the sensitivities and specificities between these studies and ours, it is suggested that the CAM-ICU is valid for use within a wide range of sedation values.…”

Validation of the Greek version of confusion assessment method for the intensive care unit (CAM-ICU)

“…In addition, observation of K statistics in separated features of the scale has shown slightly descending K values for features 3 and 4 (0.63 and 0.67). Analogous K values for features 3 and 4 are reported by the Korean version (Heo et al, 2011). Appropriate training is important for the use of CAM-ICU especially for feature 3 which seems to be the most difficult to assess in nonverbal patients and perhaps the most subjective of the four features (Ely and Truman, 2005).…”

Validity and reliability of the Thai version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)

“…The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a highly sensitive and reliable tool for the diagnosis of delirium in the ICU 4. The CAM-ICU has been translated into several languages, including German,3 Dutch,19 Swedish,20 Greek,8 Portuguese,10 Spanish,21 Chinese,22 and Korean 9. A Thai version of the CAM-ICU (Thai CAM-ICU) has already been produced, however, it has not yet been validated.…”