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Confusion assessment method in the diagnostics of delirium among aged hospital patients: would it serve better in screening than as a diagnostic instrument?
Int J Geriatr Psychiatry. 2002 Dec; 17(12):1112-9.IJ

Abstract

BACKGROUND

The Confusion Assessment Method (CAM) is an easy, four-step algorithmic diagnostic test developed to detect delirium.

OBJECTIVE

To determine how sensitive and specific the CAM is in diagnosing delirium when compared with fully operationalized criteria of delirium according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) editions III, III revised, and IV, and the International Classification of Diseases (ICD) 10th edition.

METHODS

A cross-sectional study with blinded assessments was performed on consecutive elderly patients (>70 years) (n=81) in two acute geriatric hospitals in Helsinki, Finland. The sensitivity, specificity, likelihood ratios, and positive and negative predictive values of CAM were assessed with the DSM-III, DSM-III-R, DSM-IV, and ICD-10 criteria of delirium used as reference standards.

RESULTS

Sensitivity rates of the CAM were proved to be only moderate (0.81-0.86) against all formal criteria of delirium. The specificity rates were lower (0.63-0.84), and far less than reported in previous studies using global assessment of the reference standard. Instead of the DSM-III-R, from which it is derived, the CAM seems more concordant with the DSM-IV criteria of delirium. The likelihood ratio for a positive CAM test was 5.06 and for a negative test 0.23, when compared with the DSM-IV.

CONCLUSION

The CAM seems to be an acceptable screening instrument for delirium, but the diagnosis should be ensured according to the formal criteria of delirium, preferably by the DSM-IV.

Authors+Show Affiliations

Helsinki University Hospital, Department of Medicine, Geriatric Clinic, Helsinki, Finland. jouko.laurila@fimnet.fiNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12461759

Citation

Laurila, J V., et al. "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, vol. 17, no. 12, 2002, pp. 1112-9.
Laurila JV, Pitkala KH, Strandberg TE, et al. Confusion assessment method in the diagnostics of delirium among aged hospital patients: would it serve better in screening than as a diagnostic instrument? Int J Geriatr Psychiatry. 2002;17(12):1112-9.
Laurila, J. V., Pitkala, K. H., Strandberg, T. E., & 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(12), 1112-9.
Laurila JV, et al. Confusion Assessment Method in the Diagnostics of Delirium Among Aged Hospital Patients: Would It Serve Better in Screening Than as a Diagnostic Instrument. Int J Geriatr Psychiatry. 2002;17(12):1112-9. PubMed PMID: 12461759.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Confusion assessment method in the diagnostics of delirium among aged hospital patients: would it serve better in screening than as a diagnostic instrument? AU - Laurila,J V, AU - Pitkala,K H, AU - Strandberg,T E, AU - Tilvis,R S, PY - 2002/12/4/pubmed PY - 2003/2/14/medline PY - 2002/12/4/entrez SP - 1112 EP - 9 JF - International journal of geriatric psychiatry JO - Int J Geriatr Psychiatry VL - 17 IS - 12 N2 - BACKGROUND: The Confusion Assessment Method (CAM) is an easy, four-step algorithmic diagnostic test developed to detect delirium. OBJECTIVE: To determine how sensitive and specific the CAM is in diagnosing delirium when compared with fully operationalized criteria of delirium according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) editions III, III revised, and IV, and the International Classification of Diseases (ICD) 10th edition. METHODS: A cross-sectional study with blinded assessments was performed on consecutive elderly patients (>70 years) (n=81) in two acute geriatric hospitals in Helsinki, Finland. The sensitivity, specificity, likelihood ratios, and positive and negative predictive values of CAM were assessed with the DSM-III, DSM-III-R, DSM-IV, and ICD-10 criteria of delirium used as reference standards. RESULTS: Sensitivity rates of the CAM were proved to be only moderate (0.81-0.86) against all formal criteria of delirium. The specificity rates were lower (0.63-0.84), and far less than reported in previous studies using global assessment of the reference standard. Instead of the DSM-III-R, from which it is derived, the CAM seems more concordant with the DSM-IV criteria of delirium. The likelihood ratio for a positive CAM test was 5.06 and for a negative test 0.23, when compared with the DSM-IV. CONCLUSION: The CAM seems to be an acceptable screening instrument for delirium, but the diagnosis should be ensured according to the formal criteria of delirium, preferably by the DSM-IV. SN - 0885-6230 UR - https://www.unboundmedicine.com/medline/citation/12461759/Confusion_assessment_method_in_the_diagnostics_of_delirium_among_aged_hospital_patients:_would_it_serve_better_in_screening_than_as_a_diagnostic_instrument L2 - https://doi.org/10.1002/gps.753 DB - PRIME DP - Unbound Medicine ER -