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    A tale of two methods: chart and interview methods for identifying delirium

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    Authors
    Saczynski, Jane S.
    Kosar, Cyrus M.
    Xu, Guoquan
    Puelle, Margaret R.
    Schmitt, Eva
    Jones, Richard N.
    Marcantonio, Edward R.
    Wong, Bonnie
    Isaza, Ilean
    Inouye, Sharon K.
    UMass Chan Affiliations
    Meyers Primary Care Institute
    Department of Medicine, Division of Geriatric Medicine
    Document Type
    Journal Article
    Publication Date
    2014-03-01
    Keywords
    Aged
    Aged, 80 and over
    Cohort Studies
    Delirium
    Female
    Humans
    Interview, Psychological
    Male
    *Medical Records
    Prospective Studies
    *Psychological Tests
    Reproducibility of Results
    Severity of Illness Index
    Diagnosis
    Geriatrics
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    Link to Full Text
    http://dx.doi.org/10.1111/jgs.12684
    Abstract
    OBJECTIVES: To compare chart- and interview-based methods for identification of delirium. DESIGN: Prospective cohort study. SETTING: Two academic medical centers. PARTICIPANTS: Individuals aged 70 and older undergoing major elective surgery (N = 300) (majority orthopedic surgery). MEASUREMENTS: Participants were interviewed daily during hospitalization for delirium using the Confusion Assessment Method (CAM; interview-based method), and their medical charts were reviewed for delirium using a validated chart-review method (chart-based method). Rate of agreement of the two methods and characteristics of those identified using each approach were examined. Predictive validity for clinical outcomes (length of stay, postoperative complications, discharge disposition) was compared. In the absence of a criterion standard, predictive value could not be calculated. RESULTS: The cumulative incidence of delirium was 23% (n = 68) according to the interview-based method, 12% (n = 35) according to the chart-based method, and 27% (n = 82) according to the combined approach. Overall agreement was 80%; kappa was 0.30. The methods differed in detection of psychomotor features and time of onset. The chart-based method missed delirium in individuals that the CAM identified who were lacking features of psychomotor agitation or inappropriate behavior. The CAM-based method missed chart-identified cases occurring during the night shift. The combined method had high predictive validity for all clinical outcomes. CONCLUSIONS: Interview- and chart-based methods have specific strengths for identification of delirium. A combined approach captures the largest number and broadest range of delirium cases. Geriatrics Society.
    Source
    J Am Geriatr Soc. 2014 Mar;62(3):518-24. doi: 10.1111/jgs.12684. Link to article on publisher's site
    DOI
    10.1111/jgs.12684
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/37284
    PubMed ID
    24512042
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1111/jgs.12684
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