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Agreement between NU-DESC and CAM-ICU for delirium in high-complexity hospital settings
César Flores-Galicia1, Gandhy Ponce-Gomez2, Alejandra Valencia-Cruz3
1Facultad de Enfermería y Obstetricia, Universidad Nacional Autónoma de México (UNAM-FENO), Mexico City, Mexico.
Objective:
To analyse the agreement between NU-DESC and CAM-ICU scales in detecting hyperactive and hypoactive delirium in adult patients at a tertiary hospital, testing the alternative hypothesis (HA) of significant concordance.
Method:
Cross-sectional study of 105 patients (18-85 years) under moderate sedation and ventilatory weaning, assessed with NU-DESC and CAM-ICU at three time points after staff training. Concordance was evaluated using the Kappa index.
Results:
Mean age: 45 years (52% male, 48% female). Initial agreement: Kappa = .758 (good, p < .001); second measurement: Kappa = .448 (moderate, p < .001); third measurement: Kappa = .848 (very good, p < .001). Variability reflects differences in sensitivity across delirium phases.
Discussion:
NU-DESC was optimal for initial screening (speed), while CAM-ICU showed higher accuracy in advanced stages. Their combined use captures dynamic delirium manifestations.
Conclusion:
HA was confirmed, proving that integrating NU-DESC and CAM-ICU enhances delirium detection and management in critically ill patients, adapting to their evolving clinical needs.
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