scholarly journals Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers

2019 ◽  
Vol 49 (1) ◽  
pp. 130-134
Author(s):  
Krishan Yadav ◽  
Valérie Boucher ◽  
Pierre-Hugues Carmichael ◽  
Philippe Voyer ◽  
Debra Eagles ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sensitivity And Specificity ◽  
Primary Outcome ◽  
Screening Tool ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Multicenter Cohort Study ◽  
Delirium Assessment ◽  
Lengths Of Stay ◽  
History Of

Abstract Background delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients. Objectives to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients. Design a prospective observational multicenter cohort study. Setting four Quebec EDs. Participants independent or semi-independent older patients (age ≥ 65 years) with an ED stay of at least 8 hours that required hospitalisation. Measurements eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium were calculated. Results we enrolled 301 patients (mean age 77 years, 49.5% male, 3.0% with a history of mild dementia). Thirty patients (10.0%) were CAM positive for delirium. Patients had a median of three O3DY assessments. Serial O3DY evaluations to detect delirium among patients with at least one abnormal O3DY had a sensitivity of 86.7% (95% confidence interval—CI 69.3–96.2%) and a specificity of 44.3% (95%; CI 38.3–50.4%). Conclusion serial O3DY testing demonstrates good sensitivity as a screening tool to detect delirium among older adult patients with prolonged ED lengths of stay. Emergency physicians should consider the use of the serial O3DY over clinician gestalt to improve delirium detection.

scholarly journals Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 903-910 ◽  
Author(s):  
Anne-Julie Gagné ◽  
Philippe Voyer ◽  
Valérie Boucher ◽  
Alexandra Nadeau ◽  
Pierre-Hugues Carmichael ◽  
...  
Keyword(s):  
Emergency Department ◽  
Screening Tool ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Systematic Screening ◽  
French Version ◽  
Administration Time ◽  
Older Inpatients ◽  
Patients At Risk

CLINICIAN’S CAPSULEWhat is known about the topic?Delirium is frequent in older inpatients but often goes undetected. A short tool, the 4 A’s Test (4AT), was created and validated for the detection of delirium.What did this study ask?This study compared the performance of the French version of the 4AT (4AT-F) with the Confusion Assessment Method (CAM) for the screening of delirium.What did this study find?The 4AT-F was a fast and reliable screening tool for delirium in the emergency department (ED).Why does this study matter to clinicians?Because of its quick administration time, it allows for systematic screening of patients at risk of delirium and cognitive impairment.

scholarly journals Delirium Screening in the Emergency Department: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Qian Zhang ◽  
Meixi Chen ◽  
Liangying Hou ◽  
Ziqi Guo ◽  
Qing Zhang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Relative Sensitivity ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Screening Tools ◽  
Cochrane Library ◽  
Diagnostic Tools

Abstract Background: Delirium is a complex syndrome characterized by a disturbance in attention and awareness, with a prevalence of 10-20% in patients admitted to the Emergency Department (ED). Screening tools have been developed to identify delirium in the ED, but their accuracy of screening remains unclear. To address this challenge, we conducted a comprehensive meta-analysis to systematically review the accuracy of delirium screening tools currently being used to assess ED patients.Methods: PubMed, PsycINFO, EMBASE, and the Cochrane Library were searched. Studies involving ED inpatients which compared diagnostic tools with the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria as a reference standard were included. Two reviewers independently screened the studies, extracted data, and assessed the quality of studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 scale. We conducted a conventional meta-analysis for each screening tool. Then we used network meta-analysis method to calculate the relative sensitivity and specificity among the diagnostic tests. The diagnostic accuracies were then ranked through the superiority index.Results: Thirteen studies included six screening tools. The pooled sensitivity and specificity for the Confusion Assessment Method (CAM) were 0.71 and 0.98, and for 4AT (Arousal, Attention, Abbreviated Mental Test 4, Acute change) were 0.83 and 0.93, respectively. The other four tools used were only reported in one or two studies. Their sensitivity ranged from 0.70 to 1.00, and their specificity ranged from 0.64 to 0.99. Moreover, network meta-analysis indicated that the CAM and 4AT had a greater superiority index and a higher diagnostic accuracy.Conclusions: The available data suggested that both the CAM and 4AT can be used as efficient screening tools for the ED patients.

scholarly journals Association of education with occurrence of delirium in patients from an emergency department

2016 ◽  
Vol 10 (3) ◽  
pp. 198-203
Author(s):  
Simone Sieben da Mota ◽  
Vera Beatriz Delgado ◽  
Artur Francisco Schumacher-Schuh ◽  
Marcia Lorena Fagundes Chaves
Keyword(s):  
Emergency Department ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cognitive Status ◽  
Logistic Regression Models ◽  
Educational Backgrounds ◽  
Charlson Comorbidity Score ◽  
History Of ◽  
Lower Education ◽  
State Examination

ABSTRACT Background: Delirium is a neuropsychiatric syndrome with multiple etiological factors. Evaluation of delirium in different settings, especially the Emergency Department (ED) pertaining to different regions of the world with patients from different cultural and educational backgrounds is needed. Objective: To determine the prevalence of delirium and its association with education in an ED in Brazil during a 6-month period. Methods: Patients aged >18 years were randomly selected from ED admissions. The instruments Confusion Assessment Method (CAM) scale, Mini-Mental State Examination (MMSE), Wechsler Logical Memory (WLM) and Charlson comorbidity score were applied to evaluate delirium, cognitive status, and comorbidities. Results: The prevalence of delirium was10.7%. Delirium patients had significantly lower education, MMSE and WLM (immediate and delayed) scores, with 97.4% presenting episodic memory impairment. Patients with delirium had more history of neurological disorders. Three logistic regression models evaluating the association of variables with delirium were developed. Age and MMSE were retained in the first model, WLM scores in the second, and education in the third. Conclusion: To the best of our knowledge, this is the first study estimating the prevalence of delirium in a Brazilian ED. Lower education was associated with the occurrence of delirium.

scholarly journals Validation of the Confusion Assessment Method for the Intensive Care Unit in Older Emergency Department Patients

2014 ◽  
Vol 21 (2) ◽  
pp. 180-187 ◽  
Author(s):  
Jin H. Han ◽  
Amanda Wilson ◽  
Amy J. Graves ◽  
Ayumi Shintani ◽  
John F. Schnelle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Confusion Assessment ◽  
Emergency Department Patients

Delirium classification by the diagnostic and statistical manual – a moving target

2015 ◽  
Vol 27 (6) ◽  
pp. 881-882 ◽  
Author(s):  
Karin J. Neufeld
Keyword(s):  
Rating Scale ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Classification Systems ◽  
Diagnostic Systems ◽  
Delirium Assessment ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Medical Inpatients ◽  
Dsm Iv

The following paper, entitled “A Comparison of Delirium Diagnosis in Elderly Medical Inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 Criteria” by Adamis and colleagues, reports the results of a single delirium assessment of 200 medical inpatients, aged 70 years and older. The aim was to compare the prevalence of delirium using two different diagnostic classification systems (DSM-5 and DSM-IV) and two commonly used research tools (Confusion Assessment Method and the Delirium Rating Scale-Revised ‘98). This editorial focuses on the comparison of the two versions of the DSM. The authors conclude that, while both diagnostic systems identify a core concept of delirium, the DSM-IV criteria are the most inclusive of the four approaches and the DSM-5, the most restrictive, identifying a prevalence of 19.5% and 13%, respectively in this sample. Furthermore, they conclude that these two systems do not appear to detect the same patients: only 14 of 26 (54%) individuals identified as delirious by the more exclusive DSM-5 criteria were also identified as such by DSM-IV.

scholarly journals Effect of Delirium on Physical Function in Noncardiac Thoracic Surgery Patients

2020 ◽  
Vol 29 (2) ◽  
pp. e39-e43
Author(s):  
Sikandar H. Khan ◽  
Chenjia Xu ◽  
Sophia Wang ◽  
Sujuan Gao ◽  
Sue Lasiter ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Thoracic Surgery ◽  
Physical Function ◽  
Secondary Analysis ◽  
Functional Independence ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Fisher Exact Test ◽  
Exact Test ◽  
History Of

Background The effect of delirium on physical function in patients undergoing noncardiac thoracic surgery has not been well described and may differ from that in other surgical populations. Objective To determine the effects of delirium on muscle strength and functional independence. The primary end point was change in Medical Research Council sum score (MRC-SS) by delirium status. Methods A secondary analysis of data from a clinical trial involving English-speaking adults aged 18 years or older who were undergoing major noncardiac thoracic surgery. Exclusion criteria were history of schizophrenia, Parkinson disease, dementia, alcohol abuse, or neuroleptic malignant syndrome; haloperidol allergy; being pregnant or nursing; QT prolongation; and taking levodopa or cholinesterase inhibitors. Delirium was assessed twice daily using the Confusion Assessment Method for the Intensive Care Unit. Preoperatively and postoperatively, muscle strength was assessed using the modified MRC-SS and functional independence was assessed using the Katz scale of activities of daily living. Changes in MRC-SS and Katz score by delirium status were analyzed using the Fisher exact test. Results Seventy-three patients were included in the analysis. Median (interquartile range) MRC-SS and Katz score before surgery did not differ significantly between patients without and with delirium (MRC-SS: 30 [30-30] vs 30 [30-30], P > .99; Katz score: 6 [6-6] vs 6 [6-6], P = .63). The percentage of patients with a change in MRC-SS was similar in patients without and with delirium (17% vs 13%, respectively; P > .99). More patients in the delirium group had a change in Katz score (13% vs 0%, P = .04). Conclusions Postoperative delirium was not associated with change in muscle strength. Follow-up studies using other muscle measures may be needed.

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

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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