@article{5257583c0219420e871d4028f3b98b5d,
title = "Derivation and Validation of a Severity Scoring Method for the 3-Minute Diagnostic Interview for Confusion Assessment Method--Defined Delirium",
abstract = "Objectives: 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. Design: Derivation and validation analysis in a prospective cohort study. Setting: Two academic medical centers. Participants: Individuals aged 70 and older enrolled in the Successful Aging after Elective Surgery Study undergoing major elective noncardiac surgery (N = 566). Measurements: 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. Results: 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. Conclusion: 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.",
author = "Vasunilashorn, {Sarinnapha M.} and Jamey Guess and Long Ngo and Donna Fick and Jones, {Richard N.} and Schmitt, {Eva M.} and Kosar, {Cyrus M.} and Saczynski, {Jane S.} and Travison, {Thomas G.} and Inouye, {Sharon K.} and Marcantonio, {Edward R.}",
note = "Funding Information: The authors gratefully acknowledge the contributions of the participants, family members, nurses, physicians, staff members, and members of the Executive Committee who participated in the SAGES Study. A revised version of the 3D-CAM instrument (Version 3.0 or higher) to be used for creating a 3D-CAM-S severity score using the new methods presented here is now available at www.hospitalelderlifeprogram.org. Conflict of Interest: The authors have no conflicts of interest to disclose. This research was supported by grants from the National Institute on Aging (T32AG023480 (Vasunilashorn), K01AG033643 (Saczynski), P01AG031720 (Inouye), R01AG044518 (Inouye/Jones), K07AG041835 (Inouye), R01AG030618 (Marcantonio), R01AG051658 (Marcantonio), K24AG035075 (Marcantonio)), the National Heart Lung and Blood Institute (U01HL105268 (Saczynski)), the National Institute of Nursing Research (R01NR011042 (Fick)), and the Charles A. King Trust Postdoctoral Research Fellowship Program, Bank of America, N.A., Co-Trustee (Vasunilashorn). Dr. Inouye holds the Milton and Shirley F. Levy Family Chair. Author Contributions: Vasunilashorn, Guess, Ngo, Fick, Jones, Schmitt, Kosar, Saczynski, Travison, Inouye, Marcantonio: study concept and design. Ngo, Jones, Schmitt, Kosar, Travison, Inouye, Marcantonio: acquisition of subjects and data. Vasunilashorn, Guess, Ngo, Fick, Jones, Schmitt, Kosar, Saczynski, Travison, Inouye, Marcantonio: analysis and interpretation of data. Vasunilashorn, Guess, Ngo, Fick, Jones, Schmitt, Kosar, Saczynski, Travison, Inouye, Marcantonio: preparation of manuscript. Sponsor's Role: None of the sponsors were involved in the design, methods, subject recruitment, data collection, analysis, or preparation of the paper. Publisher Copyright: {\textcopyright} 2016, Copyright the Authors Journal compilation {\textcopyright} 2016, The American Geriatrics Society",
year = "2016",
month = aug,
day = "1",
doi = "10.1111/jgs.14234",
language = "English (US)",
volume = "64",
pages = "1684--1689",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "8",
}