title: Derivation and Validation of a Severity Scoring Method for the 3-Minute Diagnostic Interview for Confusion Assessment Method--Defined Delirium.
abstract: To derive and validate a method for scoring delirium severity using a recently validated, brief, structured diagnostic interview for Confusion Assessment Method (CAM)-defined delirium (3D-CAM) and to demonstrate its agreement with the CAM Severity short form (CAM-S SF) as the reference standard.
  
  
  
  Derivation and validation analysis in a prospective cohort study.
  
  
  
  Two academic medical centers.
  
  
  
  Individuals aged 70 and older enrolled in the Successful Aging after Elective Surgery Study undergoing major elective noncardiac surgery (N = 566).
  
  
  
  The sample was randomly divided into a derivation dataset (n = 377) and an independent validation dataset (n = 189). These datasets were used to develop a severity scoring method using the 3D-CAM based on the four-item CAM-S SF (3D-CAM-S) and evaluate agreement between the 3D-CAM-S and the traditional CAM-S SF using weighted kappa statistics.
  
  
  
  A method for scoring severity using 3D-CAM items was developed that achieved good agreement with the CAM-S SF in the derivation dataset (κ = 0.94, 95% confidence interval (CI) = 0.93-0.95). The 3D-CAM-S achieved nearly identical agreement in the independent validation dataset (κ = 0.93, 95% CI = 0.92-0.95), and 100% of 3D-CAM-S scores were within 1 point of the CAM-S SF score in both datasets. The 3D-CAM-S also strongly predicts clinical outcomes.
  
  
  
  A newly developed method for scoring delirium severity using the 3D-CAM (the 3D-CAM-S) has excellent agreement with the CAM-S SF. This new methodology enables clinicians and researchers using the 3D-CAM for surveillance to measure delirium severity and monitor its course simultaneously by tracking changes over time. The 3D-CAM-S expands the utility of the 3D-CAM as an important tool for delirium recognition and management.
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.|Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors.forename: Sarinnapha M
authors.initials: SM
authors.lastname: Vasunilashorn
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Jamey
authors.initials: J
authors.lastname: Guess
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Long
authors.initials: L
authors.lastname: Ngo
authors.affiliation: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.|Department of Psychiatry, College of Nursing and College of Medicine, Pennsylvania State University, University Park, Pennsylvania.
authors.forename: Donna
authors.initials: D
authors.lastname: Fick
authors.affiliation: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.|Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Richard N
authors.identifier: 0000-0002-1049-218X
authors.initials: RN
authors.lastname: Jones
authors.affiliation: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Schmitt
authors.affiliation: Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island.
authors.forename: Cyrus M
authors.initials: CM
authors.lastname: Kosar
authors.affiliation: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.|Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, Massachusetts.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Saczynski
authors.affiliation: Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.|Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Travison
authors.affiliation: Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.|Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.|Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015331:Cohort Studies; D003221:Confusion / Q000145:classification* / Q000175:diagnosis*; D003693:Delirium / Q000145:classification* / Q000175:diagnosis*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011446:Prospective Studies; D011594:Psychometrics / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D063189:Symptom Assessment / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data*
keywords: Confusion Assessment Method; delirium; delirium severity