Translation of the CAM-ICU-7 Delirium Severity Scale

Helle Svenningsen, Dorthe Sørensen, Anne Højager Nielsen, Neil Duncan Gow

Research output: Contribution to conference without a publisher/journalAbstractResearchpeer-review


The growing amount of validated delirium checklists and screening instruments are relevant to non-native English speakers. This work’s purpose is to highlight the importance of using validated methods to translate instruments from one language to another.
Delirium is an international condition, but the conceptual equivalent can be difficult to translate. The World Health Organization (WHO) describes the process to translate the instrument from English into various languages while staying conceptually equivalent in each target country/culture (1).
In 2005, the author first used WHO's method to translate CAM-ICU (2). It has since become Denmark’s most-used instrument for delirium screening (3). In the past 15 years, however, the Danish language and the knowledge of delirium have advanced. Considering this progress, we repeated the translation process (this time with the CAM-ICU-7) to benefit from this instrument’s new features.

As recommend by WHO (1), two Danish ICU nurses fluent in English independently did forward translations and discussed differences between the two translations until reaching an agreement. For the expert back-translation, the combined Danish version was sent to a native English-speaking ICU nurse who has worked in Denmark for many years. This nurse was unfamiliar with the English version of CAM-ICU-7. As seen in the present table, some work has yet to be done before the pretest.
Pretests will be conducted at two university hospitals and one regional hospital in Denmark. Skilled ICU nurses and doctors will be asked to use the CAM-ICU-7 for delirium assessment. Interviews with them afterwards will evaluate the face validity and elucidate language or conceptual considerations.
Based on interviews and discussions in the translation group, the final version will be ready for the conference in June 2020.

Examples from all four items
Danish version for back-translation The back-translation The original CAM-ICU-7 Delirium Severity Scale
Akut ændret eller svingende mental status A sudden change in or fluctuating of mental status. Acute Onset or Fluctuation of Mental Status
Uopmærksomhed Unawareness Inattention
Tilstede, hvis den aktuelle RASS score er forskellig fra 0, dvs. patienten er andet end rolig og opmærksom. Present when the current RASS score is different from 0. In other words, the patient is other than calm and attentive. Present if the Actual RASS score is anything other than alert and calm (zero)
Det tæller som fejl, hvis patienten svarer forkert på et spørgsmål. It counts as a mistake if the patient answers a question incorrectly. Errors are counted when the patient incorrectly answers a question.

Although CAM-ICU-7 is a short and relatively simple instrument, the process revealed several translation details that might influence the instrument’s validity if the WHO guidelines are not used. The developer of any delirium-screening instrument should request adherence to the WHO-guidelines when consenting to translation.
Original languageEnglish
Publication date15 Jun 2020
Publication statusPublished - 15 Jun 2020
EventAmerican Delirium Society (ADS) 2020 Annual Meeting - Online p.g.a. Covid-19 pandemi, Indianapolis, United States
Duration: 15 Jun 2020 → …


ConferenceAmerican Delirium Society (ADS) 2020 Annual Meeting
LocationOnline p.g.a. Covid-19 pandemi
Country/TerritoryUnited States
Period15/06/20 → …
Internet address


  • health, nutrition and quality of life

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