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Translation, retranslation and validation of the Dutch Confusion Assessment Method for the Intensive Care Unit


Delirium is a common problem in hospital settings, and the prevalence of delirium varies among different hospital inpatient populations (42–87%). As in other patient populations, early detection of delirium in the ICU is a necessary first step for successful treatment and prevention. The Dutch Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a rapid and easily administrated screening instrument to detect delirium and is based on the DSM-IV. The aim of this study was to translate, retranslate and validate the CAM-ICU for use in Dutch ICU settings.


The translation of the CAM-ICU was done by standard translation guidelines, which include preparation, forward translation/reconciliation, retranslation by an official translator, harmonization and validation. Secondly, the validation study of the Dutch CAM-ICU version itself was performed in a large Dutch community hospital with a mixed ICU. The patients were tested by a geriatrician or a psychiatrist for symptoms of delirium according to the DSM-IV criteria. The CAM-ICU testing was done independently by a trained research nurse but within the same hour in which the geriatrician or psychiatrist tested the patient, as to minimise the bias of fluctuations in delirium symptoms during the day. Agreement was calculated using crosstabs analysis and the Kappa statistic.


Thirty consecutive adult patients with a Richmond Agitation and Sedation Score -3/+4 were included in the study, 60 paired tests for delirium were carried out and 30 CAM-ICU instruments were completed. Only three patients were diagnosed differently by the geriatrician or psychiatrist and the CAM-ICU; two had a psychiatric disorder and one had been sedated between the two measurements. Overall agreement was 90% (K > 0.81, P < 0.001).


The translation of the Dutch CAM-ICU showed good correlation with the original English version developed by W Ely and can therefore be used in a Dutch intensive care setting. The results of the validation study showed very good agreement between the clinical diagnoses made by the geriatrician or psychiatrist and the detection of delirium using the Dutch CAM-ICU. It therefore provides the means for early and reliable detection of ICU delirium in a Dutch ICU setting.


  1. ICU Delirium and Cognitive Impairment Study Group[]

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Vreeswijk, R., Honing, M., Bakker, K. et al. Translation, retranslation and validation of the Dutch Confusion Assessment Method for the Intensive Care Unit. Crit Care 12 (Suppl 2), P515 (2008).

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