Diagnostic Interview For CAM-defined Delirium Research Articles

Effect of the clinical decision assessment system on clinical outcomes of delirium in hospitalized older adults: study protocol for a pair-matched, parallel, cluster randomized controlled superiority trial

BackgroundPrompt recognition of delirium is the first key step in its proper management. A previous study has demonstrated that nurses’ delirium screening using the usual paper version assessment tool has no effect on clinical outcomes. Clinical decision assessment systems have been demonstrated to improve patients’ adherence and clinical outcomes. Therefore, We developed a clinical decision assessment system (3D-DST) based on the usual paper version (3-min diagnostic interview for CAM-defined delirium), which was developed for assessing delirium in older adults with high usability and accuracy. However, no high quality evidence exists on the effectiveness of a 3D-DST in improving outcomes of older adults compared to the usual paper version.MethodsA pair-matched, open-label, parallel, cluster randomized controlled superiority trial following the SPIRIT checklist. Older patients aged 65 years or older admitted to four medical wards of a geriatric hospital will be invited to participate in the study. Prior to the study, delirium prevention and treatment interventions will be delivered to nurses in both the intervention and control groups. The nurses in the intervention group will perform routine delirium assessments on the included older patients with 3D-DST, while the nurses in the control group will perform daily delirium assessments with the usual paper version. Enrolled patients will be assessed twice daily for delirium by a nurse researcher using 3D-DST. The primary outcome is delirium duration. The secondary outcomes are delirium severity, incidence of delirium, length of stay, in-hospital mortality, adherence to delirium assessment, prevention, and treatment of medical staff.DiscussionThis study will incorporate the 3D-DST into clinical practice for delirium assessment. If our study will demonstrate that 3D-DST will improve adherence with delirium assessment and clinical outcomes in older patients, it will provide important evidence for the management of delirium in the future.Trial registrationChinese Clinical Trial Registry, Identifier: ChiCTR1900028402. https://www.chictr.org.cn/showproj.aspx?proj=47127. Protocol version: 1, 29/7/22.

Accuracy of a clinical decision support system based on the 3-minute diagnostic interview for CAM-defined delirium: A validation study✰

ObjectiveTo evaluate the accuracy of the 3D-DST for delirium assessment in older adults by the nurse researcher. MethodsThe 3D-DST was administered by a trained nurse researcher to assess delirium among eligible older adults (aged ≥70 years). The criteria for identifying delirium was based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). ResultsA total of 95 older adults were enrolled in the current study, and 23 patients were identified as positive for delirium by the psychiatrist. The sensitivity and specificity of the 3D-DST were 96% and 94%, respectively. High sensitivities of the 3D-DST were also observed among patients with hypoactive delirium (95%) and those with cognitive impairment (93%). ConclusionThe 3D-DST was demonstrated as an appropriate instrument with highly acceptable sensitivities and specificities for delirium detection in hospitalized older patients.

Validity and reliability of the Thai 3-Minute Diagnostic Interview for CAM-defined Delirium (Thai 3D-CAM)

Validity and reliability of the Thai 3-Minute Diagnostic Interview for CAM-defined Delirium (Thai 3D-CAM)

Association Between Postoperative Long-Term Heart Rate Variability and Postoperative Delirium in Elderly Patients Undergoing Orthopedic Surgery: A Prospective Cohort Study.

BackgroundPostoperative delirium (POD) is a common complication after orthopedic surgery in elderly patients. The elderly may experience drastic changes in autonomic nervous system (ANS) activity and circadian rhythm disorders after surgery. Therefore, we intend to explore the relationship between postoperative long-term heart rate (HR) variability (HRV), as a measure of ANS activity and circadian rhythm, and occurrence of POD in elderly patients.MethodsThe study population of this cohort was elderly patients over 60 years of age who scheduled for orthopedic surgery under spinal anesthesia. Patients were screened for inclusion and exclusion criteria before surgery. Then, participants were invited to wear a Holter monitor on the first postoperative day to collect 24-h electrocardiographic (ECG) data. Parameters in the time domain [the standard deviation of the normal-to-normal (NN) intervals (SDNN), mean of the standard deviations of all the NN intervals for each 5-min segment of a 24-h HRV recording (SDNNI), and the root mean square of successive differences of the NN intervals (RMSSD)] and frequency domain [heart rate (HR), high frequency (HF), low frequency (LF), very low frequency (VLF), ultra low frequency (ULF), and total power (TP)] were calculated. Assessment of delirium was performed daily up to the seventh postoperative day using the Chinese version of the 3-Min Diagnostic Interview for CAM-defined Delirium (3D-CAM). The relationship between HRV and POD, as well as the association between HRV and duration of POD, was assessed.ResultsOf the 294 cases that finally completed the follow-up, 60 cases developed POD. Among the HRV parameters, SDNNI, VLF, and ULF were related to the occurrence of POD. After adjustment for potential confounders, the correlation between HRV indices and POD disappeared. Through stratified analysis, two significant negative correlations emerged: ULF in young-old participants and SDNNI, VLF, and ULF in male patients.ConclusionThe lower HRV parameters may be related to the occurrence of POD, and this correlation is more significant in young-old and male patients. ANS disorders and rhythm abnormalities reflected by HRV changes may represent a possible mechanism that promotes POD.

Cerebral autoregulation in the operating room and intensive care unit after cardiac surgery

BackgroundCerebral autoregulation monitoring is a proposed method to monitor perfusion during cardiac surgery. However, limited data exist from the ICU as prior studies have focused on intraoperative measurements. Our objective was to characterise cerebral autoregulation during surgery and early ICU care, and as a secondary analysis to explore associations with delirium. MethodsIn patients undergoing cardiac surgery (n=134), cerebral oximetry values and arterial BP were monitored and recorded until the morning after surgery. A moving Pearson's correlation coefficient between mean arterial proessure (MAP) and near-infrared spectroscopy signals generated the cerebral oximetry index (COx). Three metrics were derived: (1) globally impaired autoregulation, (2) MAP time and duration outside limits of autoregulation (MAP dose), and (3) average COx. Delirium was assessed using the 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM) and the Confusion Assessment Method for the ICU (CAM-ICU). Autoregulation metrics were compared using χ2 and rank-sum tests, and associations with delirium were estimated using regression models, adjusted for age, bypass time, and logEuroSCORE. ResultsThe prevalence of globally impaired autoregulation was higher in the operating room vs ICU (40% vs 13%, P<0.001). The MAP dose outside limits of autoregulation was similar in the operating room and ICU (median 16.9 mm Hg×h; inter-quartile range [IQR] 10.1–38.8 vs 16.9 mm Hg×h; IQR 5.4–35.1, P=0.20). In exploratory adjusted analyses, globally impaired autoregulation in the ICU, but not the operating room, was associated with delirium. The MAP dose outside limits of autoregulation in the operating room and ICU was also associated with delirium. ConclusionsMetrics of cerebral autoregulation are altered in the ICU, and may be clinically relevant with respect to delirium. Further studies are needed to investigate these findings and determine possible benefits of autoregulation-based MAP targeting in the ICU.

Validation of the 3-minute diagnostic interview for CAM-defined Delirium in Chinese older adults

Delirium is a common complication among older adults, but it is often unrecognized in routine practice. The 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM) was developed to identify delirium in the general unit. This prospective diagnostic study was conducted to validate the accuracy of the 3D-CAM Chinese version among older adults in the general units. A total of 204 hospitalized older adults from a geriatric hospital were enrolled in the study, of whom 54 were identified as positive for delirium. The sensitivity and specificity of the 3D-CAM Chinese version were 94% and 97%, respectively. The median duration of assessment using the 3D-CAM was about 3 minutes. The 3D-CAM had highly acceptable sensitivity and specificity when it was used by nurse researchers among Chinese older adults.

A nurse-administered 3-Minute diagnostic interview for CAM-defined Delirium (3D-CAM Chinese version) in hospitalized elderly patients: A validation study

BackgroundDelirium is a common complication in hospitalized elderly patients, yet often remains unrecognized in the clinical care unit. The newly developed 3-Minute Diagnostic Interview for CAM-Defined Delirium (3D-CAM) has high sensitivity and specificity when administered by trained researchers. However, diagnostic characteristics of the 3D-CAM as performed in routine practice are unclear. ObjectiveTo determine the diagnostic characteristics of a Chinese version of the 3D-CAM administered to hospitalized elderly patients by bedside nurses. DesignA prospective cohort study. SettingA tertiary geriatric hospital in China. Participants323 patients and 49 bedside nurses. MethodsThis prospective cohort study was conducted at a tertiary geriatric hospital in China. A Chinese version of 3D-CAM was administered by trained bedside nurses and compared against the reference standard performed by experienced neurologists using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. All assessors were blinded to each other's assessment results. Sensitivity and specificity of the 3D-CAM among bedside nurses were analysed by comparing with the reference standard to test the ability of 3D-CAM in detecting delirium. ResultsA total of 323 patients were included in the study, of whom 64 were classified as delirium positive by the neurologists. The 3D-CAM had a sensitivity of 92% (95% confidence interval, 82–97%), specificity of 89% (95% confidence interval, 84–92%), respectively. ConclusionThe Chinese version of 3D-CAM demonstrated good performance as a bedside nurse-administered screening tool for delirium detection among hospitalized Chinese geriatric patients.Registration number: ChiCTR-IOR-17,010,368

Validation of 3-minute diagnostic interview for CAM-defined Delirium to detect postoperative delirium in the recovery room: A prospective diagnostic study.

Recent guidelines on postoperative delirium (POD) recommend POD screening in all patients, using a validated tool, starting in the recovery room. An operationalisation of the Confusion Assessment Method (CAM) criteria, the 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM), has been developed for use in general medical units. The aim of this study was to evaluate 3D-CAM performance in an adult patient population to detect POD in the recovery room. A prospective diagnostic study. Recovery room of a tertiary care university hospital in Berlin, Germany, in 2017. Patients at least 18 years of age undergoing elective surgery. Patients were subjected to evaluation by blinded investigators using the 3D-CAM and the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5, reference standard). Sensitivity, specificity and positive predictive value (PPV) and negative predictive value (NPV) were analysed for 3D-CAM, in addition to test-retest and inter-rater reliability analyses. Sixteen out of 176 patients (9.1%) developed POD. The 3D-CAM demonstrated strong test performance (specificity 0.88, sensitivity 1.0, area under the curve 0.94, PPV 0.44 and NPV 1.0), with a test-retest reliability of 90% (n = 10) and inter-rater reliability of 80% (n = 10). In this diagnostic study, 3D-CAM showed strong performance for detection of POD in the recovery room. Due to the low training requirements, fast application and high sensitivity, it might be particularly appropriate for clinical staff with limited experience in the assessment of POD. ClinicalTrials.gov Identifier: NCT02992717.

Problem analysis in nurses' daily use of 3-Minute Diagnostic Interview for CAM-Defined Delirium

Objective To identify and analyze the problems existing in nurses' daily use of 3-Minute Diagnostic Interview for CAM-Defined Delirium (3D-CAM) and to provide a basis for intelligent development of 3D-CAM. Methods From May to June 2018, totally 17 nurses who used printed 3D-CAM for daily evaluation of delirium in the Department of Orthopedics with a high incidence of delirium in a Class Ⅲ Grade A hospital in Beijing were selected by convenient sampling. Researchers observed and recorded the problems in nurses' daily use of 3D-CAM by task-centered walkthrough method till no new problems were found, i.e., the data were saturated and the data collection was completed. Results The 17 orthopedic nurses used printed 3D-CAM for 107 evaluations of 57 patients. According to the walk-through research, it was found that the main causes of misuse of 3D-CAM were man-made errors (n=30) , misunderstanding of items (n=7) , insufficient understanding of items (n=30) , and incomplete/missing nursing records (n=6) . Conclusions Nurses' use of printed 3D-CAM for delirium evaluation showed a high error rate and poor availability. Therefore, we need to enhance the training of delirium evaluation for nurses, conduct intelligent design and development of 3D-CAM and other delirium evaluation tools, and integrate them into the information system of hospitals so as to achieve the informatization, normalization and standardization of delirium evaluation. Key words: Nurses; Delirium; Evaluation; Problem analysis; Intelligent

3D-CAM Guideline-Conform Translation for German-Speaking Countries

Postoperative delirium (POD) is an acute change in the mental state with consciousness and attention deficits. It is a common complication after surgical procedures and can have serious consequences. Thus, the evidence- and consensus-based guidelines for POD appeals with the highest recommendation level that patients be regularly screened for delirium in the postoperative phase, from the recovery room to the fifth postoperative day and at least once per shift, using a validated test instrument for the detection of POD. In 2014, Marcantonio et al. published the 3D-CAM (3-Minute Diagnostic Interview for CAM-defined Delirium). In the 3D-CAM, the algorithm of the Confusion Assessment Method (CAM) is maintained by using individual elements that operationalize the evaluation of the criteria. Therefore, it requires less training, be faster to use, and, due to a standardized approach, has less interrater variability than the CAM, whereas the high sensitivity and specificity are maintained. Our goal was to translate the 3D-CAM from English to German, so as to make this instrument available to German-speaking countries. The translation of the 3D-CAM was based on the 2005 published guideline on Translation and Cultural Adaptation of Patient Reported Outcome Measures of the International Society for Pharmacoeconomics and Outcome Research. Three independent forward translations were harmonized to a preliminary translation, which then was translated back into the original language. Original authors reviewed the back translation. According to a cognitive debriefing, the translation was revised and in addition was adapted for use in the recovery room. Due to close contact with the original authors during the translation process, it was possible to ensure that the contents of the test instrument were remained intact during the translation process.

Chinese version of 3-Minute Diagnostic Interview for CAM-Defined Delirium and its reliability

Objective To translate the English version of 3-Minute Diagnostic Interview for CAM-Defined Delirium (3D-CAM) into Chinese, and to test the reliability of the Chinese version of 3D-CAM. Methods From August to November 2017, a total of 100 patients in Stroke Department, Respiratory Department and Orthopedics Department from a ClassⅢ hospital in Beijing were selected by convenient sampling to participate in the study. The patients were tested 194 times with the Chinese version 3D-CAM by two researchers concurrently. Epidata 3.1 and SPSS 21.0 statistic software were applied for data input and analysis respectively. The interobserver reliability was expressed by Kappa value, and the Cronbach's α coefficient was used to represent internal consistency reliability. Results The Kappa value of two researchers using 3D-CAM was 0.787, and the value of the four features from 1 to 4 were 0.774, 1.000, 0.903 and 0.797 respectively. The Cronbach's α values of the Chinese version 3D-CAM were 0.823 and 0.835 respectively. It took 3 minutes in average to complete the 3D-CAM. Conclusions The internal consistency of the Chinese version 3D-CAM is high, and the interobserver consistency when evaluating delirium is high, which can be used to assess the delirium of general ward elderly patients in China. Key words: Delirium; 3-Minute Diagnostic Interview for CAM-Defined Delirium; Chinese version; Reliability

The 3D-CAM provides a brief, easy to use, sensitive and specific delirium assessment tool for older hospitalised patients, both with and without dementia

ABSTRACT FROM: Marcantonio ER, Ngo LH, O'Connor M et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med...

Correction: Derivation and Validation of a 3-Minute Diagnostic Interview for CAM-Defined Delirium

Correction: Derivation and Validation of a 3-Minute Diagnostic Interview for CAM-Defined Delirium