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

2015 ◽  
Vol 11 (3) ◽  
pp. 176-183 ◽  
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

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>

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

2014 ◽  
Vol 27 (5) ◽  
pp. 777-784 ◽  
Author(s):  
Sónia Martins ◽  
Carla Lourenço ◽  
João Pinto-de-Sousa ◽  
Filipe Conceição ◽  
José Artur Paiva ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Predictive Value ◽  
Convergent Validity ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Intermediate Care ◽  
Reference Standard ◽  
Confusion Assessment ◽  
European Portuguese ◽  
Dsm Iv

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.

Screening, Assessment und Diagnostik von Delirien

Pflege ◽  
2007 ◽  
Vol 20 (4) ◽  
pp. 191-204 ◽  
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.

scholarly journals Frequency of delirium and subsyndromal delirium in an adult acute hospital population

2014 ◽  
Vol 205 (6) ◽  
pp. 478-485 ◽  
Author(s):  
D. Meagher ◽  
N. O'Regan ◽  
D. Ryan ◽  
W. Connolly ◽  
E. Boland ◽  
...  
Keyword(s):  
General Hospital ◽  
Rating Scale ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Acute Hospital ◽  
Point Prevalence ◽  
Point Prevalence Study ◽  
Subsyndromal Delirium ◽  
Confusion Assessment ◽  
Dsm Iv

BackgroundThe frequency of full syndromal and subsyndromal delirium is understudied.AimsWe conducted a point prevalence study in a general hospital.MethodPossible delirium identified by testing for inattention was evaluated regarding delirium status (full/subsyndromal delirium) using categorical (Confusion Assessment Method (CAM), DSM-IV) and dimensional (Delirium Rating Scale-Revised-98 (DRS-R98) scores) methods.ResultsIn total 162 of 311 patients (52%) screened positive for inattention. Delirium was diagnosed in 55 patients (17.7%) using DSM-IV, 52 (16.7%) using CAM and 58 (18.6%) using DRS-R98⩾12 with concordance for 38 (12.2%) individuals. Subsyndromal delirium was identified in 24 patients (7.7%) using a DRS-R98 score of 7–11 and 41 (13.2%) using 2/4 CAM criteria. Subsyndromal delirium with inattention (v. without) had greater disturbance of multiple delirium symptoms.ConclusionsThe point prevalence of delirium and subsyndromal delirium was 25%. There was modest concordance between DRS-R98, DSM-IV and CAM delirium diagnoses. Inattention should be central to subsyndromal delirium definitions.

Delir-Diagnostik

2007 ◽  
Vol 20 (2-3) ◽  
pp. 135-139
Author(s):  
B. Dittrich ◽  
G. Gatterer ◽  
T. Frühwald ◽  
U. Sommeregger
Keyword(s):  
Confusion Assessment Method ◽  
Assessment Method ◽  
Psychische Störung ◽  
Confusion Assessment

Zusammenfassung: Das Delir (“akuter Verwirrtheitszustand”) bezeichnet eine psychische Störung, die plötzlich auftritt, durch eine rasche Fluktuation von Bewusstseinslage und Aufmerksamkeitsleistung gekennzeichnet ist und eine organische Ursache hat. Dieses Störungsbild nimmt bei Patienten im höheren Lebensalter deutlich an Häufigkeit zu und verursacht durch verlängerte Krankenhausaufenthalte und ungünstige Krankheitsverläufe erhebliche Kosten im Gesundheitssystem. Daher erscheint eine möglichst frühe Erkennung deliranter Zustandsbilder gerade im Rahmen der Geriatrie von großer Bedeutung. Zu diesem Zweck wurde eine deutsche Version der international weit verbreiteten Confusion Assessment Method entwickelt, die für die Bedürfnisse einer Abteilung für Akutgeriatrie modifiziert wurde. Dargestellt werden die Entwicklung und erste Erfahrungen mit diesem Instrument.

3-Minute Diagnostic Interview for Confusion Assessment Method--Chinese Version

2020 ◽  
Author(s):  
Dong-Liang Mu ◽  
Pan-Pan Ding ◽  
Shu-Zhe Zhou ◽  
Mei-Jing Liu ◽  
Xin-Yu Sun ◽  
...  
Keyword(s):  
Confusion Assessment Method ◽  
Assessment Method ◽  
Diagnostic Interview ◽  
Chinese Version ◽  
Confusion Assessment

scholarly journals A Systematic Review and Pooled Prevalence of Paediatric Delirium in Critically Ill Children

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i31-i32
Author(s):  
D Semple ◽  
M M Howlett ◽  
J D Strawbridge ◽  
C V Breatnach ◽  
J C Hayden
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Critically Ill ◽  
Observational Studies ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Assessment Tools ◽  
Critically Ill Children ◽  
Confusion Assessment ◽  
Pooled Prevalence

Abstract Introduction Paediatric Delirium (PD) is a neuropsychiatric complication that occurs during the management of children in the critical care environment (Paediatric Intensive Care (PICU) and Neonatal Intensive Care (NICU). Delirium can be classified as hypoactive (decreased responsiveness and withdrawal), hyperactive (agitation and restlessness), and mixed (combined) (1). PD can be assessed using a number of assessment tools. PD has been historically underdiagnosed or misdiagnosed, having many overlapping symptoms with other syndrome such as pain and iatrogenic withdrawal syndrome (2). An appreciation of the extent of PD would help clinicians and policy makers drive interventions to improve recognition, prevention and management of PD in clinical practice. Aim To estimate the pooled prevalence of PD using validated assessment tools, and to identify risk factors including patient-related, critical-care related and pharmacological factors. Methods A systematic search of PubMed, EMBASE and CINAHL databases was undertaken. Eligible articles included observational studies or trials that estimated a prevalence of PD in a NICU/PICU population using a validated PD assessment tool. Validated tools are the paediatric Confusion Assessment Method-ICU (pCAM-ICU), the Cornell Assessment of Pediatric Delirium (CAPD), the PreSchool Confusion Assessment Method for the ICU (psCAM-ICU), pCAM-ICU severity scale (sspCAM-ICU), and the Sophia Observation Withdrawal Symptoms scale Paediatric Delirium scale (SOS-PD) (1). Only full text studies were included. No language restrictions were applied. Two reviewers independently screened records. Data was extracted using a pre-piloted form and independently verified by another reviewer. Quality was assessed using tools from the National Institutes of Health. A pooled prevalence was calculated from the studies that estimated PD prevalence using the most commonly applied tool, the CAPD (1). Results Data from 23 observational studies describing prevalence and risk factors for PD in critically ill children were included (Figure 1). Variability in study design and outcome reporting was found. Study quality was generally good. Using the validated tools prevalence ranged from 10–66% of patients. Hypoactive delirium was the most prevalent sub-class identified. Using the 13 studies that used the CAPD tool, a pooled prevalence of 35% (27%-43% 95%CI) was calculated. Younger ages, particularly less than two years old, sicker patients, particularly those undergoing mechanical and respiratory ventilatory support were more at risk for PD. Restraints, the number of sedative medications, including the cumulative use of benzodiazepines and opioids were identified as risk factors for the development of PD. PD was associated with longer durations of mechanical ventilation, longer stays and increased costs. Data on association with increased mortality risk is limited and conflicting. Conclusion PD affects one third of critical care admissions and is resource intense. Routine assessment in clinical practice may facilitate earlier detection and management strategies. Modifiable risk factors such as the class and number of sedative and analgesic medications used may contribute to the development of PD. Early mobility and lessening use of these medications present strategies to prevent PD occurrence. Longitudinal prospective multi-institutional studies to further investigate the presentations of the different delirium subtypes and modifiable risk factors that potentially contribute to the development of PD, are required. References 1. Semple D (2020) A systematic review and pooled prevalence of PD, including identification of the risk factors for the development of delirium in critically ill children. doi: 10.17605/OSF.IO/5KFZ8 2. Ista E, te Beest H, van Rosmalen J, de Hoog M, Tibboel D, van Beusekom B, et al. Sophia Observation withdrawal Symptoms-Paediatric Delirium scale: A tool for early screening of delirium in the PICU. Australian Critical Care. 2018;31(5):266–73

scholarly journals 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

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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