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

Published online by Cambridge University Press:  30 March 2005

Darryl B. Rolfson
Affiliation:
Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
Janet E. McElhaney
Affiliation:
Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
Gian S. Jhangri
Affiliation:
Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
Kenneth Rockwood
Affiliation:
Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Abstract

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.

Type
Delirium
Copyright
© 1999 International Psychogeriatric Association

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Footnotes

This work was presented in part at the annual meeting of the Canadian Society of Geriatric Medicine, Vancouver, Canada, September 1997.
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