Abstract
Objective: To provide preliminary validation of a new measure of posttraumatic confusional state (PTCS), the Confusion Assessment Protocol (CAP), that assesses 7 key symptoms of PTCS (disorientation, cognitive impairment, restlessness, fluctuation in presentation, nighttime sleep disturbance, decreased daytime arousal, psychotic-type symptoms). Design: Criterion standard investigation. Setting: Inpatient traumatic brain injury (TBI) rehabilitation program. Participants: 62 consecutive patients with moderate or severe TBI admitted for inpatient rehabilitation. Interventions: Not applicable. Main Outcome Measure: Clinical diagnosis of delirium based on Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria. Results: 38 of 44 (86%) patients who were classified as confused on the CAP met the DSM-IV criteria for delirium while only 2 of 18 (11%) patients classified as nonconfused on the CAP met the DSM-IV criteria. Overall agreement between the CAP and the DSM-IV classification was 87%. Conclusions: The CAP is a brief, structured, repeatable measure of multiple aspects of PTCS. Classification of patients as confused versus nonconfused with the CAP showed excellent agreement with clinical diagnosis of delirium using DSM-IV criteria.
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