Iranian Heart Journal

Iranian Heart Journal

Diagnostic Accuracy of CAM-ICU and NEECHAM Tools Compared With DSM-IV Criteria in Diagnosing Delirium After Coronary Artery Bypass Surgery

Document Type : Original Article

Authors
Fatemeh Chabok 1
Masoumeh Hoseinzadeh Emam 1
Rasoul Azarfarin 2
Azadeh Afzalnia 1
Hooman Bakhshandeh Abkenar 1
Zahra Amirsardari 2
1 Rajaie Cardiovascular Medical and Research Institute, Iran University of Medical Sciences, Tehran, IR Iran.
2 Congenital Heart Disease Research Center, Rajaie Cardiovascular Medical and Research Institute, Iran University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: Early diagnosis of patients in the ICU can significantly contribute to improved quality of care. This study aims to compare the diagnostic accuracy of Confusion Assessment Method for the ICU (CAM-ICU) and Nursing Evaluation and Education of Cognitive Health Assessment Model (NEECHAM) Confusion Scale tools with DSM-IV diagnostic criteria for patients who have undergone coronary artery bypass surgery (CABG).
 
Methods: In this cross-sectional study, 280 patients were examined. Delirium assessments were conducted a day after surgery. The evaluation process involved the following steps: An intensive care specialist assessed the patients’ delirium status according to the DSM-IV criteria (as the reference standard). Subsequently, the researcher evaluated the same patients using the NEECHAM tool. Finally, the researcher assessed the patients using the CAM-ICU tool. Thereafter, sensitivity, specificity, positive and negative predictive values, and Kappa agreement coefficient were measured to compare the diagnostic accuracy of both CAM-ICU and NEECHAM tools with DSM-IV.
 
Results: The frequency of delirium varied depending on the diagnostic tool used: DSM-IV: 12%;
CAM-ICU: 2.9%; and NEECHAM: 3.9%. The sensitivity and specificity values for each tool were as follows:
CAM-ICU: sensitivity: 25% (95% CI, 11.5% to 43.4%) and specificity: 98.5%.
NEECHAM: sensitivity: 34.4%, 95% CI, 18.6% to 53.2%) and specificity: 98.5%.
Both CAM-ICU and NEECHAM demonstrated a positive predictive value of 100%. The negative predictive values were 91.1% for CAM-ICU and 92.1% for NEECHAM. The Kappa coefficient was calculated to be 0.73.
 
Conclusions: There was no significant difference between the diagnostic accuracy of NEECHAM and the CAM-ICU tools in detecting delirium. Both tools demonstrated low sensitivity but high specificity in diagnosing delirium following CABG. (Iranian Heart Journal 2025; 26(1): 93-101)
Keywords
Delirium
CAM-ICU tool
NEECHAM tool
ICU
Coronary artery bypass surgery
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Iranian Heart Journal
Volume 26, Issue 1
Winter 2025
Pages 93-101