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

Published online by Cambridge University Press:  02 October 2014

Sónia Martins ,
Carla Lourenço ,
João Pinto-de-Sousa ,
Filipe Conceição ,
José Artur Paiva ,
Mário R. Simões  and
Lia Fernandes
Sónia Martins
Affiliation:
Research and Education Unit on Aging/UNIFAI–University of Porto, Rua Jorge de Viterbo Ferreira, nº 228, 4050-313 Porto, Portugal
Carla Lourenço
Affiliation:
UCISU, Intensive Medicine Service, CHSJ, Porto. Al. Hernâni Monteiro, 4200-319 Porto, Portugal
João Pinto-de-Sousa
Affiliation:
Department of Surgery, Faculty of Medicine, University of Porto, Al. Hernâni Monteiro, 4200-319 Porto, Portugal
Filipe Conceição
Affiliation:
UCISU, Intensive Medicine Service, CHSJ, Porto. Al. Hernâni Monteiro, 4200-319 Porto, Portugal
José Artur Paiva
Affiliation:
Intensive Medicine and Emergency Autonomous Management Unit, CHSJ. Faculty of Medicine, University of Porto, Al. Hernâni Monteiro, 4200–319 Porto, Portugal
Mário R. Simões
Affiliation:
Psychological Assessment Laboratory. CINEICC. Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo. Apartado 6153, 3001-802 Coimbra, Portugal
Lia Fernandes*
Affiliation:
UNIFAI/CINTESIS Research Unit. Faculty of Medicine, University of Porto, Clinic of Psychiatry and Mental Health, CHSJ, Porto. Al. Hernâni Monteiro, 4200-319 Porto, Portugal
*
Correspondence should be addressed to: Lia Fernandes, Faculty of Medicine, University of Porto. Al. Hernâni Monteiro, 4200-319 Porto, Portugal. Phone: +00351222052525. Email: [email protected].
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Abstract

Background:

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.

Keywords

deliriumagedconfusion assessment methodvalidation studysensitivity and specificityreliability
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 5 , May 2015 , pp. 777 - 784
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, DSM-III-TR, 3rd edn, revised. Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR, 4th edn, revised. Washington, DC: American Psychiatric Association.Google Scholar
Ely, E. W. et al. (2004). Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Critical Care Medicine, 32, 106–112. doi: 10.1097 /01.CCM.0000098033.94737.84.CrossRefGoogle ScholarPubMed
Fabbri, R. M., Moreira, M. A., Garrido, R. and Almeida, O. P. (2001). Validity and reliability of the Portuguese version of the confusion assessment method (CAM) for the detection of delirium in the elderly. Arquivos de Neuro-Psiquiatria, 59, 175–179.CrossRefGoogle ScholarPubMed
Farrell, K. R. and Ganzini, L. (1995). Misdiagnosing delirium as depression in medically ill elderly patients. Archives of Internal Medicine, 155, 2459–2464.CrossRefGoogle ScholarPubMed
Fick, D. M., Agostini, J. V. and Inouye, S. K. (2002). Delirium superimposed on dementia: a systematic review. Journal of the American Geriatrics Society, 50, 1723–1732.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi:10.1016 /0022-3956(75)90026-6.CrossRefGoogle Scholar
Fong, T. G. et al. (2009). Delirium accelerates cognitive decline in Alzheimer disease. Neurology, 72, 1570–1575. doi: 10.1212 /WNL.0b013e3181a4129a.CrossRefGoogle ScholarPubMed
Gonzalez, M. et al. (2004). Instrument for detection of delirium in general hospitals: adaptation of the confusion assessment method. Psychosomatics, 45, 426–431. doi: 10.1176 /appi.psy.45.5.426.CrossRefGoogle ScholarPubMed
Grover, S. and Kate, N. (2012). Assessment scales for delirium: a review. World Journal of Psychiatry, 2, 58–70. doi: 10.5498 /wjp.v2.i4.58.CrossRefGoogle ScholarPubMed
Hestermann, U. et al. (2009). Validation of a German version of the confusion assessment method for delirium detection in a sample of acute geriatric patients with a high prevalence of dementia. Psychopathology, 42, 270–276. doi: 10.1159/000224151.CrossRefGoogle Scholar
Hughes, C. G., Brummel, N. E., Vasilevskis, E. E., Girard, T. D. and Pandharipande, P. P. (2012). Future directions of delirium research and management. Best Practice & Research Clinical Anaesthesiology, 26, 395–405. doi: 10.1016 /j.bpa.2012.08.004.CrossRefGoogle ScholarPubMed
Inouye, S. K. (2003). The Confusion Assessment Method (CAM): Training Manual and Coding Guide. New Haven, CT: Yale University School of Medicine.Google Scholar
Inouye, S. K. (2006). Delirium in older persons. The New England Journal of Medicine, 354, 1157–1165. doi: 10.1056 /NEJMra052321.CrossRefGoogle ScholarPubMed
Inouye, S. K. and Charpentier, P. A. (1996). Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. Journal of American Medical Association, 275, 852–857. doi: 10.1001 /jama.1996.03530350034031.CrossRefGoogle ScholarPubMed
Inouye, S. K., Foreman, M. D., Mion, L. C., Katz, K. H. and Cooney, L. M. Jr. (2001). Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Archives of Internal Medicine, 161, 2467–2473. doi: 10.1001 /archinte.161.20.2467.CrossRefGoogle ScholarPubMed
Inouye, S. K., Leo-Summers, L., Zhang, Y., Bogardus, S. T. Jr., Leslie, D. L. and Agostini, J. V. (2005). A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method. Journal of the American Geriatrics Society, 53, 312–318. doi: 10.1111 /j.1532-5415.2005.53120.x.CrossRefGoogle ScholarPubMed
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P. and Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113, 941–948.CrossRefGoogle Scholar
Inouye, S. K., Westendorp, R. G. and Saczynski, J. S. (2013). Delirium in elderly people. Lancet, 383, 911–922. doi: 10.1016 /S0140-6736(13)60688-1.CrossRefGoogle ScholarPubMed
Jaeschke, R., Guyatt, G. and Sackett, D. L. (1994). Users’ guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid? Evidence-Based Medicine Working Group. Journal of American Medical Association, 271, 389–391. doi: 10.1001 /jama.1994.03510330081039.CrossRefGoogle Scholar
Landis, J. R. and Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.CrossRefGoogle ScholarPubMed
Laurila, J. V., Pitkala, K. H., Strandberg, T. E. and Tilvis, R. S. (2002). Confusion assessment method in the diagnostics of delirium among aged hospital patients: would it serve better in screening than as a diagnostic instrument? International Journal of Geriatric Psychiatry, 17, 1112–1119. doi: 10.1002 /gps.753.CrossRefGoogle ScholarPubMed
Leentjens, A. F. et al. (2012). Delirium: An evidence-based medicine (EBM) monograph for psychosomatic medicine practice, commissioned by the academy of psychosomatic medicine (APM) and the European association of consultation liaison psychiatry and psychosomatics (EACLPP). The Journal of Psychosomatic Research, 73, 149–152. doi: 10.1016 /j.jpsychores.2012.05.009.CrossRefGoogle Scholar
Martins, S., Simões, M. R. and Fernandes, L. (2012). Translation process and pilot study of Portuguese confusion assessment method. European Psychiatry, 27 (Suppl. 1), 453.CrossRefGoogle Scholar
McLafferty, E. and Farley, A. (2007). Delirium part two: nursing management. Nursing Standard, 21, 42–46. doi: 10.7748 /ns2007.04.21.30.42.c4541.CrossRefGoogle ScholarPubMed
McNicoll, L., Pisani, M. A., Ely, E. W., Gifford, D. and Inouye, S. K. (2005). Detection of delirium in the intensive care unit: comparison of confusion assessment method for the intensive care unit with confusion assessment method ratings. Journal of the American Geriatrics Society, 53, 495–500. doi: 10.1111 /j.1532-5415.2005.53171.x.CrossRefGoogle ScholarPubMed
Monette, J. et al. (2001). Evaluation of the confusion assessment method (CAM) as a screening tool for delirium in the emergency room. General Hospital Psychiatry, 23, 20–25. doi: 10.1016 /S0163-8343(00)00116-X.CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence (2010). Delirium: diagnosis, prevention and management. Available at: www.nice.org.uk/CG103; last accessed 1 April 2012.Google Scholar
Pompei, P., Foreman, M., Cassel, C. K., Alessi, C. and Cox, D. (1995). Detecting delirium among hospitalized older patients. Archives of Internal Medicine, 155, 301–307.CrossRefGoogle ScholarPubMed
Rockwood, K. et al. (1994). Increasing the recognition of delirium in elderly patients. Journal of the American Geriatrics Society, 42, 252–256.CrossRefGoogle ScholarPubMed
Rolfson, D. B., McElhaney, J. E., Jhangri, G. S. and Rockwood, K. (1999). Validity of the confusion assessment method in detecting postoperative delirium in the elderly. International Psychogeriatrics, 11, 431–438.CrossRefGoogle ScholarPubMed
Ryan, K., Leonard, M., Guerin, S., Donnelly, S., Conroy, M. and Meagher, D. (2009). Validation of the confusion assessment method in the palliative care setting. Palliative Medicine, 23, 40–45. doi: 10.1177 /0269216308099210.CrossRefGoogle ScholarPubMed
Teasdale, G. and Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. Lancet, 2, 81–84. doi: 10.1016 /S0140-6736(74)91639-0.CrossRefGoogle ScholarPubMed
Voyer, P., McCusker, J., Cole, M. G., St-Jacques, S. and Khomenko, L. (2007). Factors associated with delirium severity among older patients. Journal of Clinical Nursing, 16, 819–831. doi: 10.1111 /j.1365-2702.2006.01808.x.CrossRefGoogle ScholarPubMed
Wechsler, D. (1997). Wechsler Adult Intelligence Scale-III. San Antonio, TX: The Psychological Corporation.Google Scholar
Wei, L. A., Fearing, M. A., Sternberg, E. J. and Inouye, S. K. (2008). The confusion assessment method: a systematic review of current usage. Journal of the American Geriatrics Society, 56, 823–830. doi: 10.1111 /j.1532-5415.2008.01674.x.CrossRefGoogle Scholar
Wild, D. et al. (2005). Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value in Health, 8, 94–104. doi: 10.1111 /j.1524-4733.2005.04054.x.CrossRefGoogle ScholarPubMed
Witlox, J., Eurelings, L. S., de Jonghe, J. F., Kalisvaart, K. J., Eikelenboom, P. and van Gool, W. A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. Journal of American Medical Association, 304, 443–451. doi: 10.1001 /jama.2010.1013.CrossRefGoogle ScholarPubMed
Wong, C. L., Holroyd-Leduc, J., Simel, D. L. and Straus, S. E. (2010). Does this patient have delirium?: value of bedside instruments. Journal of American Medical Association, 304, 779–786. doi: 10.1001 /jama.2010.1182.CrossRefGoogle ScholarPubMed
Wongpakaran, N. et al. (2011). Diagnosing delirium in elderly Thai patients: utilization of the CAM algorithm. BMC Family Practice, 12, 65. doi: 10.1186 /1471-2296-12-65.CrossRefGoogle ScholarPubMed