A comparison of the CAM-ICU and the NEECHAM Confusion Scale in intensive care delirium assessment: an observational study in non-intubated patients

A consecutive sample of 172 non-intubated patients in a mixed ICU was assessed after a stay in the ICU for at least 24 hours. All adult patients with a Glasgow Coma Scale score of greater than 9 were included. A nurse researcher simultaneously assessed both scales once daily in the morning. A total of 599 paired observations were made.The CAM-ICU showed a 19.8% incidence of delirium. The NEECHAM scale detected incidence rates of 20.3% for delirious, 24.4% for confused, 29.7% for at risk, and 25.6% for normal patients. The majority of the positive CAM-ICU patients were detected by the NEECHAM scale. The sensitivity of the NEECHAM scale was 87% and the specificity was 95%. The positive predictive value and the negative predictive value were 79% and 97%, respectively. The diagnostic capability in cardiac surgery patients proved to be lower than in other patients.In non-intubated patients, the NEECHAM scale identified most cases of delirium which were detected by the CAM-ICU. Additional confused patients were identified in the categorical approach of the scale. The NEECHAM scale proved to be a valuable screening tool compared with the CAM-ICU in the early detection of intensive care delirium by nurses.Delirium is a well-known acute syndrome in the intensive care unit (ICU). A physical cause induces a fluctuating disturbance of the cognitive processes in the brain. The patient encounters periods of inattention in combination with disorganized thinking or a changed level in consciousness. The process is observed as a hypoactive, hyperactive, or mixed type. The hyperactive type is the least frequent one although it is the easiest to detect [1,2]. Incidence rates of intensive care delirium were reported in a range from 11% to 87% [3,4]. To develop strategies to prevent or cure this complication, validated instruments for diagnosing, screening, and quantifying are needed.The standard assessment of delirium is performed when a psychiatrist uses the Diagnostic and Statistical