Psychometric properties and feasibility of instruments for the detection of delirium in older hospitalized patients: a systematic review

Velthuijsen, Eveline L. van; Zwakhalen, Sandra; Warnier, Ron M. J.; Mulder, Wubbo J.; Verhey, Frans R.J.; Kempen, Gertrudis I. J. M.

doi:10.1002/gps.4441

Cited by 119 publications

(100 citation statements)

References 55 publications

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“…Participants were assessed using the Confusion Assessment Method, short version (s-CAM), which details the following delirium features: (1) acute onset, (2) inattention, (3) disorganised thinking, (4) altered level of consciousness [25]. The s-CAM has high sensitivity of >94% and specificity >90% for the detection of delirium and accurately distinguishes between delirium and dementia [26]. FSD was defined as persons demonstrating abnormalities in features 1 + 2 + (3 or 4).…”

Section: Methodsmentioning

confidence: 99%

Key components of the delirium syndrome and mortality: greater impact of acute change and disorganised thinking in a prospective cohort study

Diwell

Davis

Vickerstaff

et al. 2018

Preprint

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BackgroundDelirium increases the risk of mortality during an acute hospital admission. Full syndromal delirium (FSD) is associated with greatest risk and subsyndromal delirium (SSD) is associated with intermediate risk, compared to patients with no delirium - suggesting a dose-response relationship. It is not clear how individual diagnostic symptoms of delirium influence the association with mortality. Our objectives were to measure the prevalence of FSD and SSD, and assess the effect that FSD, SSD and individual symptoms of delirium (from the Confusion Assessment Method-short version (s-CAM)) have on mortality rates.MethodsExploratory analysis of a prospective cohort (aged ≥ 70 years) with acute (unplanned) medical admission (4/6/2007-4/11/2007). The outcome was mortality (data censored 6/10/2011). The principal exposures were FSD and SSD compared to no delirium (as measured by the CAM), along with individual delirium symptoms on the CAM. Cox regression was used to estimate the impact FSD and SSD and individual CAM items had on mortality.ResultsThe cohort (n=610) mean age was 83 (SD 7); 59% were female. On admission, 11% had FSD and 33% had SSD. Of the key diagnostic symptoms for delirium, 17% acute onset, 19% inattention, 17% disorganised thinking and 17% altered level of consciousness. Unadjusted analysis found FSD had an increased hazard ratio (HR) of 2.31 (95%CI 1.71, 3.12), for SSD the HR was 1.26 (1.00, 1.59). Adjusted analysis remained significant for FSD (1.55 95%CI 1.10, 2.18) but nonsignificant for SSD (HR=0.92 95% CI 0.70, 1.19). Two CAM items were significantly associated with mortality following adjustment: acute onset and disorganised thinking.ConclusionWe observed a dose-response relationship between mortality and delirium, FSD had the greatest risk and SSD having intermediate risk. The CAM items “acute onset” and “disorganised thinking” drove the associations observed. Clinically, this highlights the necessity of identifying individual symptoms of delirium.

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Section: Methodsmentioning

confidence: 99%

Key components of the delirium syndrome and mortality: greater impact of acute change and disorganised thinking in a prospective cohort study

Diwell

Davis

Vickerstaff

et al. 2018

Preprint

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“…It performed well in patients with mild cognitive impairment or in the ICU settings without endotracheal intubation. More than 28 kinds of assessment instruments are constructed and introduced to facilitate delirium screening [17,25]. These instruments significantly improved the efficacy and accuracy of delirium diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…These instruments significantly improved the efficacy and accuracy of delirium diagnosis. Of these, the CAM was proposed to be the most efficient one [17,25]. However, one deficit of the CAM is that there exists discrepancy in diagnostic criteria between interviewers even after substantial training [17].…”

Section: Discussionmentioning

confidence: 99%

Cross-cultural adaptation and validation of the 3D-CAM Chinese version in surgical ICU patients

Ding

Zhou

et al. 2020

BMC Psychiatry

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Background: Accurate diagnosis of delirium is very important for prevention and treatment. Present study was designed to validate the 3-Minute Diagnostic Interview for CAM-defined Delirium Chinese version (3D-CAM-CN) in surgical ICU patients. Methods: In this prospective diagnostic study, the 3D-CAM was translated into Chinese with culture adaption. Two interviewers (Roles A and B) independently administrated 3D-CAM-CN assessment in adult patients from postoperative days 1 to day 3. At the meantime, a panel of psychiatrists diagnosed delirium according to the Diagnostic and Statistical Manual of Mental Disorders-fifth edition as the reference standard. The sensitivity and specificity were calculated to analyze the diagnostic character of the 3D-CAM-CN. Kappa coefficient was used to evaluate interrater reliability. Results: Two hundred forty-five adult patients were assessed for at least 2 days, resulting a total of 647 pairedassessments. When compared with the reference standard, the sensitivity and specificity of the 3D-CAM-CN assessment were 87.2 and 96.7%, respectively, by Role A and 84.6 and 97.4%, respectively, by Role B, with good interrater reliability (Kappa coefficient = 0.82, P < 0.001). It also performed well in patients with mild cognitive impairment, with the sensitivity from 85.7 to 100% and the specificity from 95.7 to 96.4%. Conclusion: Our results showed that the 3D-CAM-CN can be used as a reliable and accurate instrument for delirium assessment in surgical patients.

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“…A recent review on instruments for delirium detection showed that the Delirium Observation Screening Scale is a validated tool used by nurses with good predictive validity against the DSM-IV diagnosis of delirium made by a geriatrician, with high sensitivity and specificity for delirium, and easy to apply in daily clinical practice at the bedside. [30] The scale has been translated in English and Dutch. [31] Information about delirium symptoms from medical and nursing records considering the previous 24 hours was taken into account as well.…”

Section: Methodsmentioning

confidence: 99%

Preoperative CSF Melatonin Concentrations and the Occurrence of Delirium in Older Hip Fracture Patients: A Preliminary Study

et al. 2016

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BackgroundDelirium is characterized by disturbances in circadian rhythm. Melatonin regulates our circadian rhythm. Our aim was to compare preoperative cerebrospinal fluid (CSF) melatonin levels in patients with and without postoperative delirium.MethodsProspective cohort study with hip fracture patients ≥ 65 years who were acutely admitted to the hospital for surgical treatment and received spinal anaesthesia. CSF was collected after cannulation, before administering anaesthetics. Melatonin was measured by radioimmunoassay (RIA). Data on delirium was obtained from medical and nursing records. Nurses screened every shift for delirium using the Delirium Observation Screening Scale (DOSS). If the DOSS was ≥3, a psychiatrist was consulted to diagnose possible delirium using the DSM-IV criteria. At admission, demographic data, medical history, and information on functional and cognitive status was obtained.ResultsSeventy-six patients met the inclusion criteria. Sixty patients were included in the analysis. Main reasons for exclusion were technical difficulties, insufficient CSF or exogenous melatonin use. Thirteen patients (21.7%) experienced delirium during hospitalisation. Baseline characteristics did not differ between patients with and without postoperative delirium. In patients with and without postoperative delirium melatonin levels were 12.88 pg/ml (SD 6.3) and 11.72 pg/ml (SD 4.5) respectively, p-value 0.47. No differences between patients with and without delirium were found in mean melatonin levels in analyses stratified for cognitive impairment or age.ConclusionPreoperative CSF melatonin levels did not differ between patients with and without postoperative delirium. This suggests that, if disturbances in melatonin secretion occur, these might occur after surgery due to postoperative inflammation.

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Psychometric properties and feasibility of instruments for the detection of delirium in older hospitalized patients: a systematic review

Abstract: Timely detection of delirium might reduce the negative outcomes of delirium in the long term. The Nu-DESC and CAM appear to be the most adequate instruments for detecting delirium. Copyright © 2016 John Wiley & Sons, Ltd.

Cited by 119 publications

References 55 publications

Key components of the delirium syndrome and mortality: greater impact of acute change and disorganised thinking in a prospective cohort study

Key components of the delirium syndrome and mortality: greater impact of acute change and disorganised thinking in a prospective cohort study

Cross-cultural adaptation and validation of the 3D-CAM Chinese version in surgical ICU patients

Preoperative CSF Melatonin Concentrations and the Occurrence of Delirium in Older Hip Fracture Patients: A Preliminary Study

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