Evaluation of the 3-Minute Diagnostic Confusion Assessment Method for Identification of Postoperative Delirium in Older Patients

• DOI: 10.1001/jamanetworkopen.2021.37267
• Publication Date: 2021-12-13T16:01:54Z
• Authors: Jordan Oberhaus; Wei Wang; Angela M. Mickle; Jennifer Becker; Catherine Tedeschi; Hannah R. Maybrier; Ravi T. Upadhyayula; Maxwell R. Muench; Nan Lin; Eva M. Schmitt; Sharon K. Inouye; Michael S. Avidan
• Keywords: Confusion

Delirium is a common postoperative complication in older patients that often goes undetected and might lead to worse outcomes. The 3-Minute Diagnostic Confusion Assessment Method (3D-CAM) be practical tool for routine clinical diagnosis of delirium.To assess the 3D-CAM detecting delirium compared with long-form CAM used research purposes.This cohort study enrolled ongoing trials between 2015 2018 was conducted at single tertiary US hospital. Included participants were aged 60 years or undergoing major elective surgical procedures required least 2-day hospital stay. Data analyzed February April 2019.Surgical 2 hours length requiring general anesthesia planned extubation.Patients concurrently assessed using assessment CAM, scored based on standardized cognitive assessment. Agreement these methods tested Cohen κ repeated measures, generalized linear mixed-effects model, Bland-Altman analysis.Sixteen raters 471 concurrent interviews including 299 (mean [SD] age, 69 [6.5] years), majority whom men (152 [50.8%]), White (263 [88.0%]), had noncardiac operations (211 [70.6%]). Both instruments good intraclass correlation (0.84 0.98 3D-CAM). demonstrated overall agreement (κ = 0.71; 95% CI, 0.58 0.83). According there statistically significant disagreement (estimated difference fixed effect, -0.68; -1.32 -0.05; P .04). analysis showed probability more than twice (probability ratio, 2.78; 2.44 3.23).The instrument provide pragmatic sensitive delirium, caveat overdiagnose delirium.