Diagnosis of postoperative delirium in older adults using the Confusion Assessment Method for the intensive care unit in non‐intensive care unit settings: A test modification might improve its diagnostic performance

Abstract

Aim To evaluate the diagnostic performance of the Confusion Assessment Method for the intensive care unit (CAM‐ICU) among postoperative older patients in non‐ICU settings. Methods The CAM‐ICU was used by trained staff to prospectively evaluate postoperative patients for delirium. The patients were aged ≥60 years, were in general wards and had no critical illnesses. The assessments occurred for 7 consecutive days after surgery. The results were compared with delirium diagnoses obtained by geriatricians using Diagnostic and Statistical Manual of Mental Disorders 5th edition criteria as the reference standard. Results The sensitivity of delirium detection for the CAM‐ICU was 31.6% (95% confidence interval [CI] 12.6–56.6), while the specificity was 97.6% (95% CI 94.9–99.1), positive predictive value was 50.0% (95% CI 26.3–73.7) and negative predictive value was 95.0% (95% CI 93.3–96.3). Feature 4 (disorganized thinking) yielded the highest sensitivity (60%; 95% CI 14.7–94.7), whereas feature 2 (inattention) had low sensitivity (36.8%; 95% CI 16.3–61.6). Further analyses to explore the highest sensitive criteria showed that if CAM‐ICU diagnoses were made by the presence of any two out of feature 1 (acute change or fluctuation of cognition), feature 3 (altered level of consciousness) or feature 4, the sensitivity increased substantially to 80.0% (95% CI 28.4–99.5), with a reasonably high specificity of 81.8% (95% CI 48.2–97.7). Conclusions Modification of the flow of delirium diagnosis using the CAM‐ICU appears to offer a better sensitivity for detecting delirium in non‐ICU settings. Furthermore, changing feature 2 to evaluate patients’ attention levels over a longer period of time might yield a better diagnostic performance. Geriatr Gerontol Int 2019; 19: 762–767.

Indole-3-Propionic acid, A Gut Microbiota Metabolite, Protects Against the Development of Postoperative Delirium

“…All participants received standardized perioperative care determined by their clinical treatment teams. Trained clinical research coordinators performed Confusion Assessment of Measurement (CAM) 16 , 17 in the participants on postoperative day 1 and/or 2 between 8:00 am and 12:00 noon to assess POD. Study participants who were diagnosed of POD for at least 1 of the 2 days were in the POD group, those who did not meet diagnosis for POD on either postoperative days were in the No-POD group.…”

Assessing influence of preoperative factors on delirium after cardiac surgery in elderly patients: Methodological issues

“…Because the longest mean duration of ICU stay was less than 5 days, it was unclear whether part of POD assessments were completed in the surgical ward. It has been shown that performance of POD assessment method is different between ICU and non-ICU sites [3]. Thus, we were concerned that the above unknown factors would have underestimated the incidence of POD reported in this study.…”

“…The authors were concerned regarding delirium after the patient left the ICU, and whether we may have underestimated the incidence of delirium in the study. Based on the publication of the fifth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association [3], however, delirium develops over a short period (usually hours to a few days). Indeed, according to our observations, all patients developed delirium on postoperative day (POD) 1, with the longest duration being POD 5.…”

A Comparison of Efficacy between Low-dose Dexmedetomidine and Propofol for Prophylaxis of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery: A Randomized Controlled Trial

“…Although CAM-ICU was validated in the ICU setting, delirious symptoms exhibited were still similar symptoms in non-ICU wards. 21 In cases where signs of delirium were present, a psychiatrist conducted a thorough examination and diagnosed based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). This pragmatic approach ensured a comprehensive and standardized evaluation, given the limitations of available tools in our study setting.…”