Reliability and accuracy of delirium assessments among investigators at multiple international centres

Maybrier, Hannah; Mickle, Angela; Escallier, Krisztina E.; Lin, Nan; Schmitt, Eva M.; Upadhyayula, Ravi T.; Wildes, Troy S.; Mashour, George A.; Palihnich, Kerry; Inouye, Sharon K.; Avidan, Michael S.

doi:10.1136/bmjopen-2018-023137

Cited by 32 publications

(32 citation statements)

References 14 publications

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“…Given time constraints, uncertainty, and changing conditions, delirium is often unrecognized in the ICU or is recognized in a delayed fashion. This difficulty is compounded by the lack of a gold standard for delirium assessment and the low reliability of delirium assessments without significant and continued training ( 46 ). The studies reviewed generally seemed to voice an appreciation for the challenge of predicting delirium amidst the high demands of the critical care setting.…”

Section: Discussionmentioning

confidence: 99%

ICU Delirium-Prediction Models: A Systematic Review

Ruppert

Lipori

Patel

et al. 2020

Critical Care Explorations

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Section: Discussionmentioning

confidence: 99%

ICU Delirium-Prediction Models: A Systematic Review

Ruppert

Lipori

Patel

et al. 2020

Critical Care Explorations

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“…Another valuable characteristic of the CAM is that it can be used for assessment of delirium severity [7, 20]. The trial by Maybrier et al [21] was an important antecedent to the current study. It demonstrated, using a different but similarly rigorous training approach, that investigators at multiple international sites, with varying levels of clinical experience, could reliably assess delirium using the CAM.…”

Section: Discussionmentioning

confidence: 99%

“…Members of our research team have previously demonstrated the value of actual patient training complemented by video education [21]. It is likely that the rigour of the training and the reliability of the instrument used (in this case the repeatedly validated CAM) are more important than the training method.…”

Section: Discussionmentioning

confidence: 99%

Use of the confusion assessment method in multicentre delirium trials: training and standardisation

et al. 2019

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Background Delirium occurs commonly in older adults and is associated with adverse outcomes. Multicentre clinical trials evaluating interventions to prevent delirium are needed. The Confusion Assessment Method (CAM) is a validated instrument for delirium detection. We hypothesised it would be possible for a large feasibility study to train a large number of research assistants, with varying experience levels, to conduct CAM assessments reliably in multiple hospital sites. Methods A standardised training programme was followed, incorporating structured training at a central location and at study sites. CAM practice sessions on both delirious and non-delirious patients by research assistants were conducted and, thereafter, there was ongoing inter-rater reliability assessment on the CAM between research assistant pairs at study sites. The setting was eight acute care hospitals in England and Wales. Participants were research assistants working on a multicentre feasibility study of delirium prevention. The measurement used was the Confusion Assessment Method. Results Thirty-seven research assistants were trained in CAM assessment and 33 returned training logs. The logs showed there was 100% overall agreement between research assistant pairs on 295 CAM assessments, of which 263 (89.2%) were negative for delirium and 32 (10.8%) were positive. In the course of the feasibility study, research assistants successfully completed 5065 (89.7%) of the 5645 expected CAM assessments, with minimal missing data. Conclusion Using the training methods described in this study, it is possible to achieve high quality delirium assessments for large numbers of patients with little missing data across geographically dispersed sites in multicentre studies. The standardisation of multisite delirium assessments is an important contribution to research methodology, and provides a much-needed advance for the field. Trial registration ISRCT ISRCTN01187372 . Registered 13 March 2014.

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“…The CAM long form has been demonstrated to have excellent psychometric properties for both hypoactive and hyperactive delirium 59 . Programmatic training, coupled with the highly structured use of the CAM long form (as we are doing in the trial), has demonstrated excellent inter-rater reliability of researchers 28, 60 . In addition, by complementing the CAM long form (or CAM-ICU) with validated chart review 50 , we are bolstering delirium detection and minimizing missing primary outcome assessments.…”

Section: Data Collectionmentioning

confidence: 97%

Protocol for the electroencephalography guidance of anesthesia to alleviate geriatric syndromes (ENGAGES-Canada) study: A pragmatic, randomized clinical trial

Deschamps¹,

Oberhaus²,

Mickle³

et al. 2019

F1000Res

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Background: There is some evidence that electroencephalography guidance of general anesthesia can decrease postoperative delirium after non-cardiac surgery. There is limited evidence in this regard for cardiac surgery. A suppressed electroencephalogram pattern, occurring with deep anesthesia, is associated with increased incidence of postoperative delirium (POD) and death. However, it is not yet clear whether this electroencephalographic pattern reflects an underlying vulnerability associated with increased incidence of delirium and mortality, or whether it is a modifiable risk factor for these adverse outcomes. Methods: The Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES-Canada) is an ongoing pragmatic 1200 patient trial at four Canadian sites. The study compares the effect of two anesthetic management approaches on the incidence of POD after cardiac surgery. One approach is based on current standard anesthetic practice and the other on electroencephalography guidance to reduce POD. In the guided arm, clinicians are encouraged to decrease anesthetic administration, primarily if there is electroencephalogram suppression and secondarily if the EEG index is lower than the manufacturers recommended value (bispectral index (BIS) or WAVcns below 40 or Patient State Index below 25). The aim in the guided group is to administer the minimum concentration of anesthetic considered safe for individual patients. The primary outcome of the study is the incidence of POD, detected using the confusion assessment method or the confusion assessment method for the intensive care unit; coupled with structured delirium chart review. Secondary outcomes include unexpected intraoperative movement, awareness, length of intensive care unit and hospital stay, delirium severity and duration, quality of life, falls, and predictors and outcomes of perioperative distress and dissociation. Discussion: The ENGAGES-Canada trial will help to clarify whether or not using the electroencephalogram to guide anesthetic administration during cardiac surgery decreases the incidence, severity, and duration of POD. Registration: ClinicalTrials.gov (NCT02692300) 26/02/2016

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Reliability and accuracy of delirium assessments among investigators at multiple international centres

Cited by 32 publications

References 14 publications

ICU Delirium-Prediction Models: A Systematic Review

ICU Delirium-Prediction Models: A Systematic Review

Use of the confusion assessment method in multicentre delirium trials: training and standardisation

Protocol for the electroencephalography guidance of anesthesia to alleviate geriatric syndromes (ENGAGES-Canada) study: A pragmatic, randomized clinical trial

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