Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy

Abstract

BackgroundDelirium is common in the early stages of hospitalization for a variety of acute and chronic diseases.ObjectivesTo evaluate the diagnostic accuracy of two delirium screening tools, the Confusion Assessment Method (CAM) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).MethodsWe searched MEDLINE, EMBASE, and PsychInfo for relevant articles published in English up to March 2013. We compared two screening tools to Diagnostic and Statistical Manual of Mental Disorders IV criteria. Two reviewers independently assessed studies to determine their eligibility, validity, and quality. Sensitivity and specificity were calculated using a bivariate model.ResultsTwenty-two studies (n = 2,442 patients) met the inclusion criteria. All studies demonstrated that these two scales can be administered within ten minutes, by trained clinical or research staff. The pooled sensitivities and specificity for CAM were 82% (95% confidence interval [CI]: 69%–91%) and 99% (95% CI: 87%–100%), and 81% (95% CI: 57%–93%) and 98% (95% CI: 86%–100%) for CAM-ICU, respectively.ConclusionBoth CAM and CAM-ICU are validated instruments for the diagnosis of delirium in a variety of medical settings. However, CAM and CAM-ICU both present higher specificity than sensitivity. Therefore, the use of these tools should not replace clinical judgment.

Infrared pupillometry helps to detect and predict delirium in the post-anesthesia care unit

“…There was also no significant difference in the types of surgery between the groups. PACU-D patients were older 65 (12) years (median and interquartile range IQR) versus 49 (22) years. They also underwent longer surgical procedures 119 (91) min versus 57 (74) min.…”

“…Currently, no tool or monitor is validated to screen for PACU-D. The Confusion Assessment Method Intensive Care Unit (CAM-ICU) has been used to screen for delirium in the ICU; and due to its short duration, ease of use, and high sensitivity and specificity across multiple hospital settings is ideally suited for use in the PACU [10,22,23]. CAM-ICU is a highly specific test to evaluate patients for delirium based on observation and task performance scores [24].…”

Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia

“…Delirium at admission was determined by the staff geriatricians using the Confusion Assessment Method (CAM) [22], the most used delirium detection instrument worldwide. The CAM sensitivity and specificity was reported to be over 0.90 for general hospitalized patients, and despite the limited evidence for DSD detection [23], there is evidence in favor of its use in dementia patients [24].…”

Emergency Department presentation of frail older people and interventions for management: Geriatric Emergency Department Intervention

“…Delirium is a common symptom in older adults presenting to the ED and diagnosis is reported to be missed by Emergency Physicians in between 56 and 76 % of cases [31,32]. The CAM is validated for use in ward areas, post-operative recovery [33], intensive care [34] and is one of the few geriatric tools validated for use in the ED [35]. A limitation of the CAM is that it is for use throughout the whole hospital rather than being a tool specifically for use in the ED and the particular circumstances of acutely unwell older adults at first presentation to the ED.…”