The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts
Authors
Inouye, Sharon K.Kosar, Cyrus
Tommet, Douglas
Schmitt, Eva
Puelle, Margaret R.
Saczynski, Jane S.
Marcantonio, Edward R.
Jones, Richard N.
UMass Chan Affiliations
Meyers Primary Care InstituteDepartment of Medicine, Division of Geriatric Medicine
Document Type
Journal ArticlePublication Date
2014-04-15Keywords
Activities of Daily LivingAged
Aged, 80 and over
Cognition Disorders
Delirium
Female
Hospital Costs
Humans
Length of Stay
Male
Nursing Homes
*Psychological Tests
Psychometrics
Severity of Illness Index
Geriatrics
Health Services Research
Psychiatry and Psychology
Metadata
Show full item recordAbstract
BACKGROUND: Quantifying the severity of delirium is essential to advancing clinical care by improved understanding of delirium effect, prognosis, pathophysiology, and response to treatment. OBJECTIVE: To develop and validate a new delirium severity measure (CAM-S) based on the Confusion Assessment Method. DESIGN: Validation analysis in 2 independent cohorts. SETTING: Three academic medical centers. PATIENTS: The first cohort included 300 patients aged 70 years or older scheduled for major surgery. The second included 919 medical patients aged 70 years or older. MEASUREMENTS: A 4-item short form and a 10-item long form were developed. Association of the maximum CAM-S score during hospitalization with hospital and posthospital outcomes related to delirium was evaluated. RESULTS: Representative results included adjusted mean length of stay, which increased across levels of short-form severity from 6.5 days (95% CI, 6.2 to 6.9 days) to 12.7 days (CI, 11.2 to 14.3 days) (P for trend and < 0.001) and across levels of long-form severity from 5.6 days (CI, 5.1 to 6.1 days) to 11.9 days (CI, 10.8 to 12.9 days) (P for trend andlt; 0.001). Representative results for the composite outcome of adjusted relative risk of death or nursing home residence at 90 days increased progressively across levels of short-form severity from 1.0 (referent) to 2.5 (CI, 1.9 to 3.3) (P for trend andlt; 0.001) and across levels of long-form severity from 1.0 (referent) to 2.5 (CI, 1.6 to 3.7) (P for trend and < 0.001). LIMITATION: Data on clinical outcomes were measured in an older data set limited to patients aged 70 years or older. CONCLUSION: The CAM-S provides a new delirium severity measure with strong psychometric properties and strong associations with important clinical outcomes. PRIMARY FUNDING SOURCE: National Institute on Aging.Source
Ann Intern Med. 2014 Apr 15;160(8):526-33. doi: 10.7326/M13-1927. Link to article on publisher's siteDOI
10.7326/M13-1927Permanent Link to this Item
http://hdl.handle.net/20.500.14038/30427PubMed ID
24733193Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.7326/M13-1927