Development and validation of an eight-step flowchart based on the CAM-ICU: a quick and highly adaptable tool to determine the presence of delirium in ICU patients

Abstract

Introduction: Delirium is a frequent and serious disorder in the ICU. Several tools have been developed for standardized delirium testing, of which the Confusion Assessment Method for the ICU (CAM-ICU) is the best validated and most widely used. The main limitations of the CAMICU are, however, that it is a very brief assessment of a highly fl uctuating disorder, and that the test may lack sensitivity when administered in daily practice. For research purposes, we extended the CAM-ICU. Method(s): This ongoing prospective validation study was performed in a 12-bed, mixed adult ICU of the University Medical Centre Utrecht. All patients admitted to the ICU were assessed daily and independently on delirium by two means: a junior doctor or neurologist (gold standard); and an eight-item fl owchart, based on the CAM-ICU, the reports of the bedside nurses and the administration of haloperidol. Exclusion occurred when patients remained unresponsive (RASS