Validation study of the European Portuguese version of the Confusion Assessment Method (CAM)

ABSTRACTBackground:The Confusion Assessment Method (CAM) is the most widely used delirium screening instrument. The aim of this study was to evaluate the reliability and validity of the European Portuguese version of CAM.Methods:The sample included elderly patients (≥65 years), admitted for at least 48 h, into two intermediate care units (ICMU) of Intensive Medicine and Surgical Services in a university hospital. Exclusion criteria were: score ≤11 on the Glasgow Coma Scale (GCS), blindness/deafness, inability to communicate and to speak Portuguese. For concurrent validity, a blinded assessment was conducted by a psychiatrist (DSM-IV-TR, as a reference standard) and by a trained researcher (CAM). This instrument was also compared with other cognitive measures to evaluate convergent validity. Inter-rater reliability was also assessed.Results:In this sample (n = 208), 25% (n = 53) of the patients had delirium, according to DSM-IV-TR. Using this reference standard, the CAM had a moderate sensitivity of 79% and an excellent specificity of 99%. The positive predictive value was 95%, indicating a strong ability to confirm delirium with a positive test result, and the negative predictive value was lower (93%). Good convergent validity was also found, in particular with Mini-Mental State Examination (MMSE) (rs = −0.676; p ≤0.01) and Digit Span Test (DST) forward (rs = −0.605; p ≤0.01), as well as a high inter-rater reliability (diagnostic k = 1.00; single items’ k between 0.65 and 1.00).Conclusion:Robust results on concurrent and convergent validity and good reliability were achieved. This version was shown to be a valid and reliable instrument for delirium detection in elderly patients hospitalized in intermediate care units.

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Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01842-x ◽

2021 ◽

Author(s):

Andrea Kirfel ◽

Jan Menzenbach ◽

Vera Guttenthaler ◽

Johanna Feggeler ◽

Andreas Mayr ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Elderly Patients ◽

Postoperative Delirium ◽

Confusion Assessment Method ◽

Assessment Method ◽

Hospital Length Of Stay ◽

Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

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Informal caregivers and detection of delirium in postacute care: a correlational study of the confusion assessment method (CAM), confusion assessment method-family assessment method (CAM-FAM) and DSM-IV criteria

International Journal of Older People Nursing ◽

10.1111/opn.12106 ◽

2015 ◽

Vol 11 (3) ◽

pp. 176-183 ◽

Cited By ~ 4

Author(s):

Nina M. Flanagan ◽

Gale Spencer

Keyword(s):

Informal Caregivers ◽

Confusion Assessment Method ◽

Assessment Method ◽

Correlational Study ◽

Family Assessment ◽

Confusion Assessment ◽

Dsm Iv ◽

Postacute Care

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Pilot study on the European Portuguese version of the Confusion Assessment Method

Acta Neuropsychiatrica ◽

10.1017/neu.2014.15 ◽

2014 ◽

Vol 26 (5) ◽

pp. 321-324

Author(s):

Sónia Martins ◽

Patrícia Moldes ◽

João Pinto-de-Sousa ◽

Filipe Conceição ◽

José Artur Paiva ◽

...

Keyword(s):

Pilot Study ◽

Confusion Assessment Method ◽

Assessment Method ◽

Translation Process ◽

Rater Reliability ◽

Confusion Assessment ◽

Research Guidelines ◽

European Portuguese ◽

Scale Total Score ◽

Moderate Sensitivity

ObjectiveTo present the pilot study on the European Portuguese validation of the Confusion Assessment Method (CAM).MethodsThe translation process was carried out according to International Society Pharmacoeconomics and Outcomes Research guidelines with trained researchers and inter-rater reliability assessment. The study included 50 elderly patients, admitted (≥24 h) to two intermediate care units. Exclusion criteria were: Glasgow Coma Scale (total score ≤11), blindness/deafness, inability to communicate and not able to speak Portuguese. The sensitivity and specificity of CAM were assessed, with DSM-IV-TR criteria of delirium used as a reference standard.ResultsFindings revealed excellent inter-rater reliability (k>0.81), moderate sensitivity (73%) and excellent specificity (95%).ConclusionThese preliminary results suggested that this version emerges as a promising diagnostic instrument for delirium.

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Un análisis cualitativo del rendimiento del Método de Evaluación de la Confusión

Investigación en Enfermería Imagen y Desarrollo ◽

10.11144/javeriana.ie17-2.acrm ◽

2015 ◽

Vol 17 (2) ◽

Author(s):

Carmen Carrera castro

Keyword(s):

Sensitivity And Specificity ◽

Confusion Assessment Method ◽

Assessment Method ◽

Confusion Assessment ◽

Revisión Sistemática ◽

Reliability Sensitivity ◽

Dsm Iv ◽

Academic Search

<p>Objetivo: el objetivo de esta revisión sistemática descriptiva fue realizar una síntesis y análisis cualitativo sobre el rendimiento de la escala Confusion Assessment Method (CAM) como herramienta diagnóstica en el síndrome confusional agudo (SCA). Metodología: se investigó en PubMed, PsychoInfo, MEDES, SciELO, Cochrane Plus, Medline, Embase, Central, CUIDEN, Google Académico, Academic Search, revistas, libros y búsquedas manuales de referencias bibliográficas en otros medios de divulgación científicos. Lo descriptores fueron los del MeSH: delirium, reliability, sensitivity and specificity, y el término libre: confusion assessment method, que generaron 756 artículos potencialmente aptos, desde el 2009 hasta el 2014. Resultados: se hallaron 0,66 % estudios diagnósticos, de los cuales dos fueron de validación y adaptación cultural al tailandés, uno al alemán, uno de validación en pacientes de cuidados paliativos y el último fue un estudio de cohorte comparativo de evaluación sobre el rendimiento de la escala CAM en comparación con el Manual diagnóstico y estadístico de los trastornos mentales (DSM-IV) y la Clasificación Internacional de Enfermedades (CIE-10). Conclusión: la escala CAM es una herramienta diagnóstica válida, fiable y segura con alto rendimiento, cuando es manejada por profesionales adiestrados para el diagnóstico clínico del SCA. Es necesario desarrollar más investigaciones en la práctica rutinaria de los profesionales de enfermería.</p>

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Long-term prognostic value of delirium in elderly patients with acute cardiac diseases admitted to two cardiac intensive care units: a prospective study (DELIRIUM CORDIS)

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617695235 ◽

2017 ◽

Vol 7 (7) ◽

pp. 661-670 ◽

Cited By ~ 11

Author(s):

Giovanni Falsini ◽

Simone Grotti ◽

Italo Porto ◽

Giulio Toccafondi ◽

Aureliano Fraticelli ◽

...

Keyword(s):

Elderly Patients ◽

Onset Time ◽

Confusion Assessment Method ◽

Assessment Method ◽

Cardiac Diseases ◽

Confusion Assessment ◽

Short And Long Term ◽

Cardiac Intensive Care ◽

Long Term Mortality

Background: Delirium is a frequent in-hospital complication in elderly patients, and is associated with poor clinical outcome. Its clinical impact, however, has not yet been fully addressed in the setting of the cardiac intensive care unit (CICU). The present study is a prospective, two-centre registry aimed at assessing the incidence, prevalence and significance of delirium in elderly patients with acute cardiac diseases. Methods: Between January 2014 and March 2015, all consecutive patients aged 65 years or older admitted to the CICU of our institutions were enrolled and followed for 6 months. Delirium was defined according to the confusion assessment method. Results: During the study period, 726 patients were screened for delirium. The mean age was 79.1±7.8 years. A total of 111 individuals (15.3%) were diagnosed with delirium; of them, 46 (41.4%) showed prevalent delirium (PD), while 65 (58.6%) developed incident delirium (ID). Patients 85 years or older showed a delirium rate of 52.3%. Hospital stay was longer in delirious versus non-delirious patients. Patients with delirium showed higher in-hospital, 30-day and 6-month mortality compared to non-delirious patients, irrespective of the onset time (overall, ID or PD). Six-month re-hospitalisation was significantly higher in overall delirium and the PD group, as compared to non-delirious patients. Kaplan–Meier analysis showed a significant reduction of 6-month survival in patients with delirium compared to those without, irrespective of delirium onset time (i.e. ID or PD). A positive confusion assessment method was an independent predictor of short and long-term mortality. Conclusions: Delirium is a common complication in elderly CICU patients, and is associated with a longer and more complicated hospital stay and increased short and long-term mortality. Our findings suggest the usefulness of a protocol for the early identification of delirium in the CICU. Clinicaltrials.gov: NCT02004665

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Ultrabrief Screens for Detecting Delirium in Postoperative Cognitively Intact Older Adults

Journal of Hospital Medicine ◽

10.12788/jhm.3410 ◽

2020 ◽

Vol 15 (9) ◽

pp. 544-547

Author(s):

Andrea Yevchak Sillner ◽

Long Ngo ◽

Yoojin Jung ◽

Sharon Inouye ◽

Marie Boltz ◽

...

Keyword(s):

Older Adults ◽

Postoperative Delirium ◽

Elective Surgery ◽

Confusion Assessment Method ◽

Assessment Method ◽

Reference Standard ◽

Patient Reports ◽

Confusion Assessment ◽

Overall Performance ◽

Cognitively Intact

The authors’ sought to develop an ultrabrief screen for postoperative delirium in cognitively intact patients older than 70 years undergoing major elective surgery. All possible combinations of one-, two- and three-item screens and their sensitivities, specificities, and 95% confidence intervals were calculated and compared with the delirium reference standard Confusion Assessment Method (CAM). Among the 560 participants (mean age, 77 years; 58% women), delirium occurred in 134 (24%). We considered 1,100 delirium assessments from postoperative days 1 and 2. The screen with the best overall performance consisted of three items: (1) Patient reports feeling confused, (2) Months of the year backward, and (3) “Does the patient appear sleepy?” with sensitivity of 92% and specificity of 72%. This brief, three-item screen rules out delirium quickly, identifies a subset of patients who require further testing, and may be an important tool to improve recognition of postoperative delirium.

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Hemoglobin Concentration and Post-Operative Delirium in Elderly Patients Undergoing Femoral Neck Fracture Surgery

Frontiers in Medicine ◽

10.3389/fmed.2021.780196 ◽

2022 ◽

Vol 8 ◽

Author(s):

Yu-Mei Liu ◽

Hui Huang ◽

Jie Gao ◽

Jian Zhou ◽

Hai-Chen Chu

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Femoral Neck ◽

Elderly Patients ◽

Confusion Assessment Method ◽

Assessment Method ◽

Confusion Assessment ◽

Neck Fracture ◽

Icu Transfer ◽

Hb Concentration

This study aimed to determine the relationship between hemoglobin (Hb) concentration and post-operative delirium (POD) in elderly patients undergoing femoral neck fracture (FNF) surgery and to investigate whether the change in Hb concentration is associated with POD and the risk factors for POD. A total of 889 patients admitted with FNF between January 2016 and December 2020 were enrolled in this single-center, retrospective, case–control study. Hb concentrations were determined at admission and post-operative day 1 and the change in Hb concentration was defined as the absolute value of difference in pre-operative and post-operative Hb concentration. POD was assessed using the Confusion Assessment Method for the Intensive Care Unit (ICU) or the Confusion Assessment Method once a daily after surgery. The logistic regression analysis was performed for statistical analysis. In total, 172 (19.3%) patients developed POD and 151 (87.8%) patients developed POD within post-operative 3 days. Low pre-operative Hb concentration [p = 0.026, odds ratio (OR) = 0.978] and significant change in Hb concentration (p = 0.006, OR = 1.033) were significantly associated with POD. After excluding change in Hb concentration or pre-operative Hb concentration, neither of them was significantly associated with POD (p > 0.05). The interaction analysis of change in Hb concentration and pre-operative Hb concentration in the logistic regression model was negative. There was no significant relationship between post-operative Hb concentration and POD. Age (p < 0.001, OR = 1.072), stroke history (p = 0.003, OR = 2.489), post-operative ICU transfer (p = 0.007, OR = 1.981), and visual analog scale score within post-operative 2 days (p1 = 0.016 and p2 = 0.006) were independently associated with POD in the logistic regression analysis. Patients with low pre-operative Hb concentrations and high changes in Hb concentration seem to have an increased risk of POD and should receive more attention. Old age, stroke history, post-operative ICU transfer, and pain within post-operative 2 days were significantly associated with POD.

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Confusion Assessment Method--European Portuguese Version

PsycTESTS Dataset ◽

10.1037/t60154-000 ◽

2014 ◽

Author(s):

Sónia Martins ◽

Patrícia Moldes ◽

João Pinto-de-Sousa ◽

Filipe Conceição ◽

José Artur Paiva ◽

...

Keyword(s):

Confusion Assessment Method ◽

Assessment Method ◽

Portuguese Version ◽

Confusion Assessment ◽

European Portuguese

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Screening, Assessment und Diagnostik von Delirien

Pflege ◽

10.1024/1012-5302.20.4.191 ◽

2007 ◽

Vol 20 (4) ◽

pp. 191-204 ◽

Cited By ~ 10

Author(s):

Wolfgang Hasemann ◽

Reto W. Kressig ◽

Doris Ermini-Fünfschilling ◽

Mena Pretto ◽

Rebecca Spirig

Keyword(s):

American Psychiatric Association ◽

Confusion Assessment Method ◽

Assessment Method ◽

World Health ◽

Confusion Assessment ◽

Internationale Klassifikation Der Krankheiten ◽

Icd 10 ◽

Screening Assessment ◽

Dsm Iv ◽

Health Organization

Ein Delir ist eine akute Verschlechterung der Aufmerksamkeit und Kognition. Für die Diagnosestellung stehen zwei Klassifikationssysteme zur Verfügung: Das Diagnostische und Statistische Manual Psychischer Störungen (DSM) (American Psychiatric Association, 2000) und die Internationale Klassifikation der Krankheiten (ICD) (World Health Organization, 2006). Während sich die Kernsymptome beider Klassifikationssysteme ähneln, bedarf es für die Diagnose des Delirs nach ICD-10 zusätzlicher Kriterien: Psychomotorischer Störungen, Störungen des Schlaf-Wach-Zyklus und affektiver Störungen. Daher gilt die Diagnosestellung nach ICD als strengeres Verfahren. In Abhängigkeit der untersuchten Population werden bis zu 60% der Delirien, die mittels DSM-IV Kriterien festgestellt wurden, verpasst. Für die klinische Praxis stehen zahlreiche Screening- und Assessmentinstrumente zur Verfügung. In der Regel basieren diese auf den DSM-Kriterien. In diesem Beitrag werden zwei Instrumente vorgestellt, welche Pflegefachpersonen im Rahmen des Basler Delirmanagementprogramms des Universitätsspitals Basel, Schweiz, einsetzen. Das Screening erfolgt mittels der von Schuurmans (2001) entwickelten Delir-Beobachtungs-Screening-Skala (Delirium Observatie Screening Schaal, DOS), das Assessment mittels der von Inouye, van Dyck, Alessi, Balkin, Siegal und Horwitz (1990) entwickelten Confusion Assessment Method (CAM). Während die DOS ein reines Beobachtungsinstrument ist, benötigt die CAM ein strukturiertes Interview, klassischerweise (z.B.) den Minimentalstatus nach Folstein, Folstein und McHugh (1975). Beide Instrumente wurden mittels wissenschaftlicher Kriterien ins Deutsche übersetzt. Dieser Artikel stellt die übersetzten Versionen von DOS und CAM vor, diskutiert ihren Einsatz in einer Schweizer Risikogruppe für Delir und liefert den theoretischen Hintergrund der Diagnosestellung eines Delirs auf den Grundlagen von DSM-IV und ICD-10.

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