A tale of two methods: chart and interview methods for identifying delirium
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 InstituteDepartment of Medicine, Division of Geriatric Medicine
Document Type
Journal ArticlePublication Date
2014-03-01Keywords
AgedAged, 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
Metadata
Show full item recordAbstract
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 siteDOI
10.1111/jgs.12684Permanent Link to this Item
http://hdl.handle.net/20.500.14038/37284PubMed ID
24512042Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1111/jgs.12684