Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly

Abstract

-This study has tested the validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM), a diagnostic assessment instrument for delirium developed by Inouye et al. (1990). The sample was formed by 100 patients with 60 and more years of age, admitted at the emergency service of Santa Casa de São Paulo, in the time periods between July and August, 1996, November and December, 1996 and February and March, 1997. The sensibility was 94.1% and specificity 96.4%. The assessors reliability in a sample of the 24 patients resulted in a kappa = 0.70. We have concluded that CAM is an adequate instrument to assess the presence of delirium, reliable to assess elderly patients at the emergency services.KEY WORDS: delirium ,elderly, emergency service, validity, CAM.Validação e confiabilidade da versão em língua portuguesa do confusion assessment method (CAM) para a detecção de delirium no idoso. RESUMO -O presente estudo testou a validade e confiabilidade da versão em língua portuguesa do ConfusionAssessment Method (CAM), instrumento de avaliação diagnóstica de delirium desenvolvido por Inouye e col. (1990). A amostra foi composta de 100 pacientes com idade igual ou superior a 60 anos atendidos no serviço de urgência da Santa Casa de São Paulo nos períodos de julho a agosto de 1996, novembro a dezembro de 1996 e fevereiro a março de 1997. Os resultados apontaram sensibilidade de 94,1% e especificidade de 96,4%. Confiabilidade entre avaliadores em subgrupos de 24 pacientes produziu kappa = 0,70. Concluimos que o CAM é um instrumento que afere a presença de delirium de forma adequada e que pode ser utilizado de forma confiável na avaliação de pacientes idosos atendidos em serviços de urgência. PALAVRAS-CHAVE: delirium, idoso, serviço de urgência, validação, CAM. Presently, delirium is defined as an organic brain syndrome without specific etiology, characterized by the simultaneous presence of disturbances related to consciousness and attention, perception, thinking, memory, psychomotor behavior, emotions and sleep-wake cycle 1 . Prevalence studies indicate that delirium is present in 10-24% of adults admitted to hospital and that another 32% will develop the disorder as inpatients 2,3 . Typical symptoms of delirium include reduced ability to focus and maintain attention, memory deficits, disorientation, language difficulties, illusions, hallucinations, and many other behavioral abnormalities. Infection, cardiovascular diseases, metabolic disturbances, and drug use or withdrawal are the most frequent causes of delirium 4,5 . Only 33-64% of the patients with delirium are correctly identified by practicing physician [6][7][8][9][10]

Impacto funcional da internação hospitalar de pacientes idosos

“…O número médio de medicamentos em uso (3,65 fármacos), também encontrado em outros estudos, 8,13 aponta a tendência à polifarmácia.…”

“…Foi identificado o diagnóstico principal no momento da internação de acordo com a Classificação Internacional de Doenças (CID-10). A função cognitiva foi avaliada por meio do "Mini-Exame do Estado Mental" (MEEM) 11 -30 questões que obtém valores dos domínios da orientação, memória imediata, atenção e cálculo, memória de evocação e linguagem, com a pontuação mínima de zero e máxima de 30 pontos, sendo a nota de corte 24 para determinar déficit cognitivo -e pelo Confusion Assessement Method (CAM), 8,17 instrumentos adaptados transculturalmente e validados para o idioma português.…”

Applicability of Anticholinergic Risk Scale in hospitalized elderly persons

“…The clinical diagnosis of delirium was established using the Portuguese version of the Confusion Assessment Method (CAM) translated and validated by Fabbri et al 12 and routinely used in Brazilian clinical practice since its publication in 2001. Positive cases were classified by motor subtypes of delirium 13 : a) hyperactive delirium: evidence in 24 hours prior to diagnosis of at least two of the following symptoms: quantitatively increased motor activity, loss of activity control, restlessness, perambulation; b) Hypoactive delirium: evidence in 24 hours prior to diagnosis of at least two of the following symptoms: significantly reduced activity, decreased movement speed, poor attention to surrounding environment, significantly reduced speech, decreased speech rate, indifference, reduced agility; c) Mixed delirium: evidence of two previous subtypes (hyper and hypoactive) in previous 24 hours; d) non-motor delirium: absence in the previous 24 hours of the symptoms listed in a and b to define the hyperactive and hypoactive subtypes.…”

Idosos asilados em hospitais gerais

“…44 The Confusion Assessment Method (CAM) has become the most widely used instrument, and the Brazilian translated version shows 94.1% sensitivity and 96.4% specificity. 13,28 The management of delirium patients includes identifying and treating precipitating conditions, such as infections, drugs, water and electrolyte disturbances, ischemic heart disease, pain and bone fratures. 20,40 Preventive measures are aimed at identifying risk factors and minimizing pre- cipitating events.…”

“…29,38,42 A complete neurological examination can help identify previously undetected stroke and Parkinson's disease manifestations. Assessment scales such as CAM 13,28 and the Mini Mental Status Examination (MMSE) 4,7,18 help the diagnosis and first approach of patients in confusional states and their cognitive assessment.…”