Abstract :
Background: Confusion Assessment Method for Intensive Care Unit (CAM-ICU) is a widely accepted, easily available, and quick tool for assessment of delirium in ICU. Globally, multiple studies have been conducted to cross culturally translate and validate the tool to make it fit the local setting. However, to the best of our knowledge, it has not been cross-culturally translated and validated into Amharic. Therefore, this study aims to bridge this gap.
Objective: This study aimed to assess the Validity of the Amharic Version of Confusion Assessment Method for Intensive Care Unit (CAM-ICU) among patients admitted to adult ICU in two centers in Addis Ababa, Ethiopia.
Methods and materials: An institution based cross-sectional study was conducted at the intensive care unit of Tikur Anbessa Specialized Hospital and Menelik-II Hospital. A total of 132 eligible patients were included in this study. Data were collected by nurses and resident physicians using Google form from 1-December-2023 to 30-April-2024. Data analysis was performed using to SPSS V.27. Descriptive analyses were performed using frequency and percentage for categorical variables and mean with standard deviation for continuous variables. Reliability, inter-rater reliability (k), and acceptability of the tool were assessed.
Results: The Amharic version was translated by group of experts, including anesthesiologists, psychiatrists, language experts, and the primary investigator, ensuring content and face validity. A total of 132 patients participated in this study, with a response rate of 95.65%. The Amharic version of CAM-ICU had high acceptance (100%), good reliability (Cronbach’s alpha=0.718), and substantial inter-rater agreement (k=0.762). 11 (8.3%) and 7(5.3%) of 132 patients were diagnosed with delirium by doctors and nurses, respectively, using CAM-ICU Amharic. Moreover, 7 of 132 patients (5.3%) were diagnosed with delirium concurrently by both physicians and nurses.
Conclusion: The Amharic version of CAM-ICU is an acceptable, valid, and reliable tool for delirium assessment in ICU. Utilization of CAM-ICU Amharic in clinical practice after provision of proper training would enable better detection of delirium in ICU.
Keywords :
Amharic version, CAM-ICU, Delirium, Ethiopia, Menelik-II, TASH, ValidationReferences :
- Meagher DJ, Morandi A, Inouye SK, Ely W, Adamis D, Maclullich AJ, et al. Concordance between DSM-IV and DSM-5 criteria for delirium diagnosis in a pooled database of 768 prospectively evaluated patients using the delirium rating scale-revised-98. BMC medicine. 2014;12:1-10.
- The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. BMC Med. 2014;12:141.
- Bruno JJ, Warren ML. Intensive care unit delirium. Critical care nursing clinics of North America. 2010;22(2):161-78.
- Cavallazzi R, Saad M, Marik PE. Delirium in the ICU: an overview. Annals of Intensive Care. 2012;2(1):49.
- Vasilevskis EE, Han JH, Hughes CG, Ely EW. Epidemiology and risk factors for delirium across hospital settings. Best Practice & Research Clinical Anaesthesiology. 2012;26(3):277-87.
- Ma X, Wu Q, Ran Y, Cao X, Zheng H. A bibliometric analysis on delirium in intensive care unit from 2013-2023. Front Neurol. 2025;16:1469725.
- Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell Jr FE, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Jama. 2004;291(14):1753-62.
- Jayaswal AK, Sampath H, Soohinda G, Dutta S. Delirium in medical intensive care units: Incidence, subtypes, risk factors, and outcome. Indian journal of psychiatry. 2019;61(4):352-8.
- Stollings JL, Kotfis K, Chanques G, Pun BT, Pandharipande PP, Ely EW. Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Medicine. 2021;47(10):1089-103.
- Penfold RS, Squires C, Angus A, Shenkin SD, Ibitoye T, Tieges Z, et al. Delirium detection tools show varying completion rates and positive score rates when used at scale in routine practice in general hospital settings: A systematic review. Journal of the American Geriatrics Society. 2024;72(5):1508-24.
- Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in Mechanically Ventilated PatientsValidity and Reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA. 2001;286(21):2703-10.
- Adamis D, Dimitriou C, Anifantaki S, Zachariadis A, Astrinaki I, Alegakis A, et al. Validation of the Greek version of confusion assessment method for the intensive care unit (CAM-ICU). Intensive and Critical Care Nursing. 2012;28(6):337-43.
- Ben Saida I, Kortli S, Amamou B, Kacem N, Ghardallou M, Ely EW, et al. A Tunisian version of the confusion assessment method for the intensive care unit (CAM-ICU): translation and validation. BMC psychiatry. 2020;20(1):1-8.
- Koga Y, Tsuruta R, Murata H, Matsuo K, Ito T, Ely EW, et al. Reliability and validity assessment of the Japanese version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Intensive and Critical Care Nursing. 2015;31(3):165-70.
- Larsson C, Axell AG, Ersson A. Confusion assessment method for the intensive care unit (CAM‐ICU): translation, retranslation and validation into Swedish intensive care settings. Acta Anaesthesiologica Scandinavica. 2007;51(7):888-92.
- Pipanmekaporn T, Wongpakaran N, Mueankwan S, Dendumrongkul P, Chittawatanarat K, Khongpheng N, et al. Validity and reliability of the Thai version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Clinical Interventions in Aging. 2014;9:879-85.
- Selim A, Kandeel N, Elokl M, Khater MS, Saleh AN, Bustami R, et al. The validity and reliability of the Arabic version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU): A prospective cohort study. International Journal of Nursing Studies. 2018;80:83-9.
- Toro A, Escobar L, Franco J, Diaz-Gomez J, Munoz J, Molina F, et al. Spanish version of the CAM-ICU (Confusion Assessment Method for the Intensive Care Unit). Pilot study of validation. Medicina intensiva. 2009;34(1):14-21.
- Chen T-J, Chung Y-W, Chang H-C, Chen P-Y, Wu C-R, Hsieh S-H, et al. Diagnostic accuracy of the CAM-ICU and ICDSC in detecting intensive care unit delirium: A bivariate meta-analysis. International Journal of Nursing Studies. 2021;113:103782.
- Welu SG, Gebreslassie HT, Kiros KM, Metekiya WM. Prevalence And Associated Factors Of Delirium Among Hospitalized Patients In Mekelle Public Hospitals, Mekele, Tigray, Ethiopia, a cross sectional study. 2023.
- McHugh ML. Interrater reliability: the kappa statistic. Biochemia medica. 2012;22(3):276-82.
- Tobar E, Romero C, Galleguillos T, Fuentes P, Cornejo R, Lira M, et al. Confusion Assessment Method for diagnosing delirium in ICU patients (CAM-ICU): cultural adaptation and validation of the Spanish version. Medicina intensiva. 2009;34(1):4-13.
- Pipanmekaporn T, Wongpakaran N, Mueankwan S, Dendumrongkul P, Chittawatanarat K, Khongpheng N, et al. Validity and reliability of the Thai version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Clinical interventions in aging. 2014:879-85.
- Aljuaid MH, Deeb AM, Dbsawy M, Alsayegh D, Alotaibi M, Arabi YM. Psychometric properties of the Arabic version of the confusion assessment method for the intensive care unit (CAM-ICU). BMC Psychiatry. 2018;18(1):91.
- Heo EY, Lee BJ, Hahm BJ, Song EH, Lee HA, Yoo CG, et al. Translation and validation of the Korean Confusion Assessment Method for the Intensive Care Unit. BMC Psychiatry. 2011;11:94.

