title: Detection of Delirium in Hospitalized Older General Medicine Patients: A Comparison of the 3D-CAM and CAM-ICU.
abstract: BACKGROUND
  Delirium is common in older hospitalized patients and is associated with poor outcomes, yet most cases go undetected. The best approach for systematic delirium identification outside the intensive care unit remains unknown.
  
  
  OBJECTIVE
  To conduct a comparative effectiveness study of the Confusion Assessment Method for the ICU (CAM-ICU) and the newly developed 3-minute diagnostic assessment for delirium using the Confusion Assessment Method (3D-CAM) in general medicine inpatients.
  
  
  METHODS
  Cross-sectional comparative effectiveness study.
  
  
  METHODS
  Two non-intensive care general medicine units at a single academic medical center.
  
  
  METHODS
  Hospitalized general medicine patients aged ≥75 years.
  
  
  METHODS
  Clinicians performed a reference standard assessment for delirium that included patient interviews, family interviews, and review of the medical record. An expert panel determined the presence or absence of delirium using DSM-IV criteria. Two blinded research assistants administered the CAM-ICU and the 3D-CAM in random order, and we determined their diagnostic test characteristics compared to the reference standard.
  
  
  RESULTS
  Among the 101 participants (mean age 84 ± 5.5 years, 61 % women, 25 % with dementia), 19 % were classified as delirious based on the reference standard. Evaluation times for the 3D-CAM and CAM-ICU were similar. The sensitivity [95 % confidence interval (CI)] of delirium detection for the 3D-CAM was 95 % [74 %, 100 %] and for the CAM-ICU was 53 % [29 %, 76 %], while specificity was >90 % for both instruments. Subgroup analyses showed that the CAM-ICU had sensitivity of 30 % in patients with mild delirium vs. 100 % for the 3D-CAM.
  
  
  CONCLUSIONS
  In this comparative effectiveness study, we found that the 3D-CAM had substantially higher sensitivity than the CAM-ICU in hospitalized older general medicine patients, and similar administration time. Therefore, the 3D-CAM may be a superior screening tool for delirium in this patient population.
authors.affiliation: The Commonwealth Medical College, Scranton, PA, USA.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Kuczmarska
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Long H
authors.initials: LH
authors.lastname: Ngo
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Jamey
authors.initials: J
authors.lastname: Guess
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: O'Connor
authors.affiliation: Fenway Community Health Center, Boston, MA, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Branford-White
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Kerry
authors.initials: K
authors.lastname: Palihnich
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Gallagher
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. emarcant@bidmc.harvard.edu.|Harvard Medical School, Boston, MA, USA. emarcant@bidmc.harvard.edu.|Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. emarcant@bidmc.harvard.edu.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003693:Delirium / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D005260:Female; D058006:General Practice / Q000379:methods* / Q000592:standards; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D008297:Male; D016037:Single-Blind Method; D011795:Surveys and Questionnaires / Q000592:standards
keywords: delirium; dementia; diagnosis; inpatient; screening