NEECHAM: NEECHAM Confusion Scale

This paper described construction and clinical testing of the NEECHAM scale in two acute-hospital samples and reported strong internal consistency, inter-rater reliability and construct validity. It established the observational framework but was not designed as a modern, fully blinded diagnostic-accuracy study against an independent reference standard.

This study compared nurse-applied NEECHAM with an independent DSM-IV assessment in 105 ICU patients. Sensitivity was 97% and specificity 83%, but the authors reported difficulty rating intubated patients and the sample came from one ICU.

Ward nurses applied NEECHAM and DOSS while a blinded geriatrician used DSM-IV criteria in an 87-patient cohort. In the 68 patients with complete observations across three shifts, NEECHAM sensitivity was 100% and specificity 87%; the complete-case requirement limits generalisability.

This ICU study compared NEECHAM with CAM-ICU across 599 repeated observations in 172 non-intubated patients. Sensitivity was 87% and specificity 95%, but CAM-ICU was an instrument comparator and performance was lower in cardiac-surgery patients.

This study followed 149 older hip-fracture patients using daily DSM-IV assessment and NEECHAM observation. A score below 25 was associated with about twelve times the risk of delirium; discharge sensitivity and specificity were 100% and 91%, but exclusions meant admission sensitivity could not be estimated reliably.

This small surgical-ICU study compared repeated NEECHAM ratings with CAM-ICU in 41 older patients. At a threshold of 25 it reported 99.2% sensitivity, 95% specificity and an area under the curve of 0.99, but the repeated-assessment design, small sample and instrument comparator warrant caution.

This Finnish surgical-unit study assessed 112 patients and compared NEECHAM and Nu-DESC with a CAM algorithm. It found NEECHAM internal consistency of 0.76-0.86 and inter-rater reliability of 0.87, but it primarily supports reliability and concurrent validity rather than independent DSM-based diagnostic accuracy.

This network meta-analysis included 50 ICU studies involving 6,042 adults and compared several delirium screening instruments. It included NEECHAM in the evidence network but concluded that the tool has limitations and that further high-quality validation against DSM-5 criteria is needed.