title: 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study.
abstract: BACKGROUND
  Delirium is common, leads to other adverse outcomes, and is costly. However, it often remains unrecognized in most clinical settings. The Confusion Assessment Method (CAM) is the most widely used diagnostic algorithm, and operationalizing its features would be a substantial advance for clinical care.
  
  
  OBJECTIVE
  To derive the 3D-CAM, a new 3-minute diagnostic assessment for CAM-defined delirium, and validate it against a clinical reference standard.
  
  
  METHODS
  Derivation and validation study.
  
  
  METHODS
  4 general medicine units in an academic medical center.
  
  
  METHODS
  201 inpatients aged 75 years or older.
  
  
  METHODS
  20 items that best operationalized the 4 CAM diagnostic features were identified to create the 3D-CAM. For prospective validation, 3D-CAM assessments were administered by trained research assistants. Clinicians independently did an extensive assessment, including patient and family interviews and medical record reviews. These data were considered by an expert panel to determine the presence or absence of delirium and dementia (reference standard). The 3D-CAM delirium diagnosis was compared with the reference standard in all patients and subgroups with and without dementia.
  
  
  RESULTS
  The 201 participants in the prospective validation study had a mean age of 84 years, and 28% had dementia. The expert panel identified 21% with delirium, 88% of whom had hypoactive or normal psychomotor features. Median administration time for the 3D-CAM was 3 minutes (interquartile range, 2 to 5 minutes), sensitivity was 95% (95% CI, 84% to 99%), and specificity was 94% (CI, 90% to 97%). The 3D-CAM did well in patients with dementia (sensitivity, 96% [CI, 82% to 100%]; specificity, 86% [CI, 67% to 96%]) and without dementia (sensitivity, 93% [CI, 66% to 100%]; specificity, 96% [CI, 91% to 99%]).
  
  
  CONCLUSIONS
  Limited to single-center, cross-sectional, and medical patients only.
  
  
  CONCLUSIONS
  The 3D-CAM operationalizes the CAM algorithm using a 3-minute structured assessment with high sensitivity and specificity relative to a reference standard and could be an important tool for improving recognition of delirium.
  
  
  BACKGROUND
  National Institute on Aging.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
authors.forename: Long H
authors.initials: LH
authors.lastname: Ngo
authors.forename: Margaret
authors.initials: M
authors.lastname: O'Connor
authors.forename: Richard N
authors.initials: RN
authors.lastname: Jones
authors.forename: Paul K
authors.initials: PK
authors.lastname: Crane
authors.forename: Eran D
authors.initials: ED
authors.lastname: Metzger
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003221:Confusion; D003430:Cross-Sectional Studies; D003693:Delirium / Q000175:diagnosis*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009483:Neuropsychological Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity