Validity of the Confusion Assessment Method in Detecting Postoperative Delirium in the Elderly

In this prospective cohort of 71 elderly patients undergoing cardiac surgery, each subject was interviewed before and after surgery to detect incident delirium using the Confusion Assessment Method (CAM), the Mini-Mental State Examination (MMSE), the Clock Test, and a health record review. The first...

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Bibliographic Details
Published in:International psychogeriatrics 1999-12, Vol.11 (4), p.431-438
Main Authors: Rolfson, Darryl B., McElhaney, Janet E., Jhangri, Gian S., Rockwood, Kenneth
Format: Article
Language:English
Subjects:
Aged
Confusion - diagnosis
Confusion - etiology
Coronary Artery Bypass - adverse effects
Delirium
Delirium - diagnosis
Delirium - etiology
Female
Humans
Male
Mini-Mental State Examination
Nurses
Nursing Assessment - standards
Observer Variation
Older people
Postoperative Care
Predictive Value of Tests
Prospective Studies
Psychiatric Status Rating Scales - standards
Reproducibility of Results
ROC Curve
Sensitivity and Specificity
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Summary:In this prospective cohort of 71 elderly patients undergoing cardiac surgery, each subject was interviewed before and after surgery to detect incident delirium using the Confusion Assessment Method (CAM), the Mini-Mental State Examination (MMSE), the Clock Test, and a health record review. The first 41 were assessed by a physician and the remaining 30 by two study nurses. Delirium was then diagnosed by a physician using DSM-III-R criteria. Delirium was present in 23 subjects (32.4%). The sensitivity of the CAM differed significantly when administered by physicians compared to nurses (1.00 vs. .13). When standard cutoffs were used, neither the MMSE nor the Clock Test were found to be sensitive markers for delirium (.30 and .09, respectively). Recognition of delirium by charting was superior in nurses compared to physicians (.83 vs. .30). We conclude that the sensitivity of markers for delirium, such as the CAM and health record documentation, is dependent on the training background of the operator.
ISSN:1041-6102
1741-203X
DOI:10.1017/S1041610299006043