A Tunisian version of the Confusion Assessment Method for the intensive care unit (CAM-ICU): translation and validation
Abstract Background Delirium is common in critically ill patients and is associated with poor outcomes. In Tunisia, it remains however underdiagnosed, lacking a validated screening tool. The CAM-ICU is one of the most commonly used tools for detecting delirium in ICUs. The aim of the present study was to translate and validate a Tunisian version of the CAM-ICU. Methods A forward and backward translation was performed according to the guidelines suggested by the translation and cultural adaptation group. For the validation and inter-rater reliability assessment of the Tunisian CAM-ICU, two trained intensivists independently evaluated delirium in ICU patients admitted between October 2017 and June 2018. The results were compared with the reference evaluation carried out by a psychiatrist using the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The inter-rater reliability was calculated using the kappa statistic. Results The related material of the Tunisian translated version of the CAM-ICU is currently available at the website www.icudelirium.org (last access: October 19, 2019). The study enrolled 137 patients. The Tunisian CAM-ICU showed a very high inter-rater reliability for both intensivists in terms of assessing delirium (Kappa=0.844, p<0.001). Using the DSM-5 rater as the reference standard, the sensitivity of the two intensivists’ evaluations were 80.4% vs. 95.7%. Specificity was 98.9% for both respectively. Conclusions The Tunisian version of the CAM-ICU showed excellent validity and reliability in detecting delirium in critically ill patients. It could therefore be used in Tunisian ICUs or where Tunisian translators are available following appropriate training. Trial registration: Not applicable.