Critical care, Patient acuity, Validation studies



  1. Connor, Jean A. PhD, RN, CPNP, FAAN
  2. LaGrasta, Christine DNP, RN, CPNP-PC/AC
  3. Gauvreau, Kimberlee ScD
  4. Porter, Courtney MPH, CPHQ
  5. Hickey, Patricia A. PhD, MBA, RN, NEA-BC, FAAN


Background: The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) acuity tool was developed to quantify patient acuity in terms of nursing cognitive workload complexity in a large, freestanding children's hospital in the United States.


Objectives: To describe the acuity and complexity of pediatric critical care nursing at a large children's hospital and correlate the CAMEO II with pediatric physiologic measures.


Methods: Construct validation was conducted correlating the CAMEO II to a pediatric classification system and 2 physiologic acuity tools. Descriptive statistics summarized patient characteristics. Construct validity across tools was evaluated using the Spearman correlation coefficient.


Results: CAMEO II was described both continuously and as ordinal complexity levels (I-V). Among 235 patients who completed CAMEO II across 4 intensive care units (ICUs), the mean total score was 99.06 (median, 97; range, 59-204). The CAMEO II complexity classification for 235 patients was as follows: I: 22 (9.4%), II: 53 (22.6%), III: 56 (23.8%), IV: 66 (28.1%), and V: 38 (16.2%). Findings from the 235 patients across the 4 ICUs revealed a significant correlation between the CAMEO II and the Therapeutic Intervention Scoring System-Children ([rho] = 0.567, P < .001),CAMEO II and Pediatric Risk of Mortality III ([rho] = 0.446, P < .001), and the CAMEO II and Score for Neonatal Acute Physiology Perinatal Extension II ([rho] = 0.359, P = .013).


Discussion: Utilization of CAMEO II across ICUs provides an opportunity to validate the current complexity of pediatric critical care nursing in a large children's hospital.