Validity and Reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients ☆ Ulf Guenther MD a, ⁎ , Julius Popp MD b , Lena Koecher a , Thomas Muders MD a , Hermann Wrigge MD, PhD a , E. Wesley Ely MD, MPH c , Christian Putensen MD, PhD a a Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Germany b Klinik und Poliklinik für Psychiatrie, Universitätsklinikum Bonn, Germany c Health Services Research Center, 6109 Medical Center East, Vanderbilt University School of Medicine, and the Geriatric Research Education Clinical Center (GRECC) for the Tennessee Valley Veteran's Affairs Healthcare System, Nashville, TN, USA Keywords: Delirium; Confusion; Critical care medicine; Richmond Agitation Sedation Scale Abstract Purpose: Delirium occurs frequently in critical care but often remains undiagnosed because delirium monitoring is often dismissed as being too time-consuming. This study determined the validity and reliability of the “CAM-ICU Flowsheet,” a practical, time-sparing algorithm to assess the 4 delirium criteria in intubated patients. Materials and Methods: With permission from our institution's ethics committee, patients of a 31-bed surgical intensive care unit department were screened for delirium (1) by a psychiatrist as the reference rater using the 4 delirium criteria of the Diagnostic and Statistical Manual of Mental Diseases, Fourth Edition (DSM-IV), and (2) by 2 physician investigators using a German translation of the CAM-ICU Flowsheet. Results: Fifty-four surgical ICU patients underwent the complete protocol assessment with paired observations; 46% were diagnosed with delirium by the reference rater (n = 25), 9% had hyperactive delirium (n = 5), and 37% were hypoactive (n = 20). The CAM-ICU Flowsheet investigators had sensitivities of 88% (95% confidence interval, 69%-98%) and 92% (74%-99%), specificities of 100% (85%-100%), very high interrater reliability (κ, 0.96; 0.87-1.00), and needed 50 seconds (interquartile range, 40-120 seconds) in patients with delirium vs 45 seconds (interquartile range, 40–75 seconds) in those without delirium to complete assessments. Conclusions: The CAM-ICU Flowsheet has high sensitivity, high specificity, and very high interrater reliability. False-negative ratings can occur infrequently and mostly reflect the fluctuating course of delirium. The CAM-ICU Flowsheet is a valid, reliable, and quickly performed bedside delirium instrument. © 2010 Elsevier Inc. All rights reserved. ☆ UG, JP, LK, TM, HW, and CP received departmental funding. EWE has received research grants and honoraria from NIHRO1AG027472, Hospira, Pfizer, Eli Lilly, and GlaxoSmithKline; a research grant from Aspect Medical Systems; and is an advisor for Healthways. ⁎ Corresponding author. Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum der Rheinischen Friedrich- Wilhelms Universität, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany. E-mail address: u.guenther@uni-bonn.de (U. Guenther). 0883-9441/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jcrc.2009.08.005 Journal of Critical Care (2010) 25, 144–151