Format

Send to:

Choose Destination
See comment in PubMed Commons below
J Am Geriatr Soc. 2005 Feb;53(2):312-8.

A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method.

Author information

  • 1Yale University School of Medicine, Department of Internal Medicine, New Haven, CT 06520, USA. sharon.inouye@yale.edu <sharon.inouye@yale.edu>

Abstract

OBJECTIVES:

To validate a chart-based method for identification of delirium and compare it with direct interviewer assessment using the Confusion Assessment Method (CAM).

DESIGN:

Prospective validation study.

SETTING:

Teaching hospital.

PARTICIPANTS:

Nine hundred nineteen older hospitalized patients.

MEASUREMENTS:

A chart-based instrument for identification of delirium was created and compared with the reference standard interviewer ratings, which used direct cognitive assessment to complete the CAM for delirium. Trained nurse chart abstractors were blinded to all interview data, including cognitive and CAM ratings. Factors influencing the correct identification of delirium in the chart were examined.

RESULTS:

Delirium was present in 115 (12.5%) patients according to the CAM. Sensitivity of the chart-based instrument was 74%, specificity was 83%, and likelihood ratio for a positive result was 4.4. Overall agreement between chart and interviewer ratings was 82%, kappa=0.41. By contrast, using International Classification of Diseases, Ninth Revision, Clinical Modification, administrative codes, the sensitivity for delirium was 3%, and specificity was 99%. Independent factors associated with incorrect chart identification of delirium were dementia, severe illness, and high baseline delirium risk. With all three factors present, the chart instrument was three times more likely to identify patients incorrectly than with none of the factors present.

CONCLUSION:

A chart-based instrument for delirium, which should be useful for patient safety and quality-improvement programs in older persons, was validated. Because of potential misclassification, the chart-based instrument is not recommended for individual patient care or diagnostic purposes.

PMID:
15673358
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Icon for Blackwell Publishing
    Loading ...
    Write to the Help Desk