BACKGROUND: Postoperative delirium in the elderly is common and associated with poor outcomes, but often goes unrecognized. Delirium screening tools, validated in postoperative settings are lacking. This study compares two screening tools [Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Nursing Delirium Symptom Checklist (NuDESC)] with a DSM-IV-based diagnosis of delirium, conducted by neuropsychiatric examination in postoperative settings. METHODS: Consecutive English-speaking patients, ≥70 yr, undergoing surgery with general anaesthesia and capable of providing informed consent, were recruited. Diagnostic test characteristics were compared for each screening tool vs neuropsychiatric examination, both in the Post-Anaesthesia Care Unit (PACU), and daily during inpatient hospitalization, adjusting for repeated measures. RESULTS: Neuropsychiatric examination identified delirium in 45% of 91 patients evaluated in the PACU and in 32% of 166 subsequent delirium assessments on the ward in the 58 admitted patients. The sensitivity [95% confidence interval (CI)] of delirium detection of the CAM-ICU in the PACU, and in all repeated assessments was 28% (16-45%) and 28% (17-42%), respectively; for the NuDESC (scoring threshold ≥2), 32% (19-48%) and 29% (19-42%), respectively, and the NuDESC (threshold ≥1), 80% (65-91%) and 72% (60-82%), respectively. Specificity was >90% for both the CAM-ICU and the NuDESC (threshold ≥2); specificity for the NuDESC (threshold ≥1), in the PACU was 69% (54-80%) and 80% (73-85%) for all assessments. CONCLUSIONS: While highly specific, neither CAM-ICU nor NuDESC (threshold ≥2) are adequately sensitive to identify delirium post-operatively; NuDESC (threshold ≥1) increases sensitivity, but reduces specificity.
BACKGROUND:Postoperative delirium in the elderly is common and associated with poor outcomes, but often goes unrecognized. Delirium screening tools, validated in postoperative settings are lacking. This study compares two screening tools [Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Nursing Delirium Symptom Checklist (NuDESC)] with a DSM-IV-based diagnosis of delirium, conducted by neuropsychiatric examination in postoperative settings. METHODS: Consecutive English-speaking patients, ≥70 yr, undergoing surgery with general anaesthesia and capable of providing informed consent, were recruited. Diagnostic test characteristics were compared for each screening tool vs neuropsychiatric examination, both in the Post-Anaesthesia Care Unit (PACU), and daily during inpatient hospitalization, adjusting for repeated measures. RESULTS: Neuropsychiatric examination identified delirium in 45% of 91 patients evaluated in the PACU and in 32% of 166 subsequent delirium assessments on the ward in the 58 admitted patients. The sensitivity [95% confidence interval (CI)] of delirium detection of the CAM-ICU in the PACU, and in all repeated assessments was 28% (16-45%) and 28% (17-42%), respectively; for the NuDESC (scoring threshold ≥2), 32% (19-48%) and 29% (19-42%), respectively, and the NuDESC (threshold ≥1), 80% (65-91%) and 72% (60-82%), respectively. Specificity was >90% for both the CAM-ICU and the NuDESC (threshold ≥2); specificity for the NuDESC (threshold ≥1), in the PACU was 69% (54-80%) and 80% (73-85%) for all assessments. CONCLUSIONS: While highly specific, neither CAM-ICU nor NuDESC (threshold ≥2) are adequately sensitive to identify delirium post-operatively; NuDESC (threshold ≥1) increases sensitivity, but reduces specificity.
Entities:
Keywords:
aged; delirium; neuropsychological tests; perioperative period; sensitivity and specificity
Authors: Alawi Luetz; Anja Heymann; Finn M Radtke; Chokri Chenitir; Ulrike Neuhaus; Irit Nachtigall; Vera von Dossow; Susanne Marz; Verena Eggers; Andreas Heinz; Klaus D Wernecke; Claudia D Spies Journal: Crit Care Med Date: 2010-02 Impact factor: 7.598
Authors: F M Radtke; M Franck; M Schneider; A Luetz; M Seeling; A Heinz; K D Wernecke; C D Spies Journal: Br J Anaesth Date: 2008-07-03 Impact factor: 9.166
Authors: Finn M Radtke; Martin Franck; Sabine Schust; Lina Boehme; Andreas Pascher; Hermann J Bail; Matthes Seeling; Alawi Luetz; Klaus-D Wernecke; Andreas Heinz; Claudia D Spies Journal: World J Surg Date: 2010-03 Impact factor: 3.352
Authors: E Card; P Pandharipande; C Tomes; C Lee; J Wood; D Nelson; A Graves; A Shintani; E W Ely; C Hughes Journal: Br J Anaesth Date: 2014-12-23 Impact factor: 9.166
Authors: Marcos G Lopez; Christopher G Hughes; Anthony DeMatteo; Jason B O'Neal; J Brennan McNeil; Matthew S Shotwell; Jennifer Morse; Michael R Petracek; Ashish S Shah; Nancy J Brown; Frederic T Billings Journal: Anesthesiology Date: 2020-03 Impact factor: 7.892
Authors: Anita Hargrave; Jesse Bastiaens; James A Bourgeois; John Neuhaus; S Andrew Josephson; Julia Chinn; Melissa Lee; Jacqueline Leung; Vanja Douglas Journal: Psychosomatics Date: 2017-07-24 Impact factor: 2.386
Authors: Christopher G Hughes; Christina S Boncyk; Deborah J Culley; Lee A Fleisher; Jacqueline M Leung; David L McDonagh; Tong J Gan; Matthew D McEvoy; Timothy E Miller Journal: Anesth Analg Date: 2020-06 Impact factor: 5.108
Authors: Elizabeth L Whitlock; Brian A Torres; Nan Lin; Daniel L Helsten; Molly R Nadelson; George A Mashour; Michael S Avidan Journal: Anesth Analg Date: 2014-04 Impact factor: 5.108
Authors: Charles H Brown; Julia Probert; Ryan Healy; Michelle Parish; Yohei Nomura; Atsushi Yamaguchi; Jing Tian; Kenton Zehr; Kaushik Mandal; Vidyulata Kamath; Karin J Neufeld; Charles W Hogue Journal: Anesthesiology Date: 2018-09 Impact factor: 7.892
Authors: Aleksandra Kuczmarska; Long H Ngo; Jamey Guess; Margaret A O'Connor; Laura Branford-White; Kerry Palihnich; Jacqueline Gallagher; Edward R Marcantonio Journal: J Gen Intern Med Date: 2016-03 Impact factor: 5.128