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The authors reply.

e1162 www.ccmjournal.org November 2020 • Volume 48 • Number 11 Second, evaluation of interobserver agreement between experts and family members is important. Steis et al (3) demonstrated a good kappa value of 0.85 between two independent raters for the use of FAM-CAM. However, the authors should determine whether the interobserver agreement in the study by Fiest et al (1) was the same as in previous studies. Family assessments can be affected by disease severity and treatment variations in the ICU. Krewulak et al (4) evaluated the feasibility and acceptability of FAM-CAM and Sour Seven in the ICU. However, they demonstrated that in 26% of cases, scoring was not completed because of the inability to reconnect with family members and overwhelming of family members. Third, a more difficult but important issue in the clinical setting would be evaluation of delirium in pediatric patients. Pediatric CAM-ICU has been proposed for assessment of delirium in critically ill children (5). However, frequent evaluation of inattention, altered level of consciousness, and disorganized thinking using pediatric CAM-ICU would be hard work for bedside nurses. This drawback might explain the infrequent use of pediatric CAM-ICU. Therefore, we are extremely interested in whether FAM-CAM and Sour Seven might be useful tools for evaluating delirium in critically ill children and in determining if these tools can be adequately used by family members. In conclusion, we suggest that the authors provide additional data to further elucidate the diagnostic accuracy of family-administered tools to detect delirium in ICU patients. Supported, in part, by KAKENHI Grants from the Japan Society for the Promotion of Science (Numbers JP 20H03782 and 20K08541), the Strategic Information and Communications R&D Promotion Programme, and the Japan Agency for Medical Research and Development. The authors have disclosed that they do not have any potential conflicts of interest.