The validity and reliability of the portuguese versions of three tools used to diagnose delirium in critically ill patients

OBJECTIVES: The objectives of this study are to compare the sensitivity and specificity of three diagnostic tools for delirium (the Intensive Care Delirium Screening Checklist, the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet) in a mixed population of critically ill patients, and to validate the Brazilian Portuguese Confusion Assessment Method for Intensive Care Units. METHODS: The study was conducted in four intensive care units in Brazil. Patients were screened for delirium by a psychiatrist or neurologist using the Diagnostic and Statistical Manual of Mental Disorders. Patients were subsequently screened by an intensivist using Portuguese translations of the three tools. RESULTS: One hundred and nineteen patients were evaluated and 38.6% were diagnosed with delirium by the reference rater. The Confusion Assessment Method for Intensive Care Units had a sensitivity of 72.5% and a specificity of 96.2%; the Confusion Assessment Method for Intensive Care Units Flowsheet had a sensitivity of 72.5% and a specificity of 96.2%; the Intensive Care Delirium Screening Checklist had a sensitivity of 96.0% and a specificity of 72.4%. There was strong agreement between the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet (kappa coefficient = 0.96) CONCLUSION: All three instruments are effective diagnostic tools in critically ill intensive care unit patients. In addition, the Brazilian Portuguese version of the Confusion Assessment Method for Intensive Care Units is a valid and reliable instrument for the assessment of delirium among critically ill patients.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal da Bahia University Hospital Prof. Edgar Santos Intensive Care UnitD'Or Institute of Research and EducationInstituto Nacional do Câncer Intensive Care UnitUniversidade do Extremo Sul Catarinense Laboratório de Fisiopatologia ExperimentalInstituto Nacional de Ciência e Tecnologia Translacional em MedicinaInstituto Nacional do Câncer Neurosurgery SectionUniversidade Federal da Bahia University Hospital Prof. Edgar Santos Department of PsychiatryUniversidade Federal da Bahia Instituto de Ciências da Saúde Programa de Pós-graduação em Processos Interativos dos Órgãos e SistemasUniversidade Federal de São Paulo (UNIFESP) Department of Psychiatry Laboratório Interdisciplinar de Neurosciências ClínicasHarvard School of Public Health Departments of Society, Human Development, and Health & EpidemiologyUNIFESP, Department of Psychiatry Laboratório Interdisciplinar de Neurosciências ClínicasSciEL