Diagnosing delirium in older hospitalized adults with dementia: adapting the confusion assessment method to international classification of diseases, tenth revision, diagnostic criteria
Objectives: To compare performance characteristics of the Confusion Assessment Method (CAM) algorithm for screening and delirium diagnosis with criteria for delirium from the International Classification of Diseases, Tenth Revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders,...
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| Main Authors: | , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
6 August 2012
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| In: |
Journal of the American Geriatrics Society
Year: 2012, Volume: 60, Issue: 8, Pages: 1471-1477 |
| ISSN: | 1532-5415 |
| DOI: | 10.1111/j.1532-5415.2012.04066.x |
| Online Access: | Verlag, Pay-per-use, Volltext: http://dx.doi.org/10.1111/j.1532-5415.2012.04066.x Verlag, Pay-per-use, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-5415.2012.04066.x 
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| Author Notes: | Christine Thomas, Stefan H. Kreisel, Peter Oster, Martin Driessen, Volker Arolt, and Sharon K. Inouye |
| Summary: | Objectives: To compare performance characteristics of the Confusion Assessment Method (CAM) algorithm for screening and delirium diagnosis with criteria for delirium from the International Classification of Diseases, Tenth Revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) in high-risk individuals. Design: Prospective cohort study. Setting: Academic geriatric hospital. Participants: One hundred two individuals aged 80 to 100 hospitalized for acute medical illness. Measurements: Complete CAM instrument (nine items), scored using the four-item CAM diagnostic algorithm. Criterion standard classification of delirium was rated independently according to expert consensus based on DSM-IV and ICD-10 criteria for delirium. Results: In 79 hospitalized participants, the CAM performed well for delirium screening (delirium prevalence of 24% according to DSM-IV and 14% according to ICD-10). Of all CAM features, acute onset and fluctuating course are most important for diagnosis (area under the receiver operating characteristic curve (AUC) = 0.92 in DSM-IV and 0.83 in ICD-10). The CAM diagnostic algorithm had a sensitivity of 0.74, a specificity of 1.0, and an AUC of 0.88 compared with the DSM-IV reference standard and a sensitivity of 0.82, a specificity of 0.91, and an AUC of 0.85 compared with the ICD-10. Compared with the ICD-10, adding psychomotor change to the CAM algorithm improved specificity to 97%, but sensitivity fell to 55% (AUC = 0.96). Applying psychomotor change sequentially only to the group that the CAM algorithm identified as having no delirium improved sensitivity to 91% with specificity of 85% (AUC = 0.95). Conclusion: Although the CAM diagnostic algorithm performed well against a DSM-IV reference standard, adding psychomotor change to the CAM algorithm improved specificity and diagnostic value against ICD-10 criteria overall in older adults with dementia and improved sensitivity and screening performance when applied sequentially in CAM-negative individuals. |
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| Item Description: | Gesehen am 02.05.2018 |
| Physical Description: | Online Resource |
| ISSN: | 1532-5415 |
| DOI: | 10.1111/j.1532-5415.2012.04066.x |