Edward R Marcantonio1, Richard N Jones2,3, Sharon K Inouye1,2, Cyrus M Kosar2, Douglas Tommet2, Eva M Schmitt2, Margaret R Puelle2, Jane S Saczynski4. 1. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 2. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife. 3. Departments of Psychiatry and Human Behavior and Neurology, Brown University Warren Alpert Medical School, Providence RI. 4. Division of Geriatric Medicine and Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA.
Abstract
BACKGROUND: Quantifying the severity of delirium is essential to advancing clinical care by improved understanding of delirium effect, prognosis, pathophysiology, and response to treatment. OBJECTIVE: To develop and validate a new delirium severity measure (CAM-S) based on the Confusion Assessment Method. DESIGN: Validation analysis in 2 independent cohorts. SETTING: Three academic medical centers. PATIENTS: The first cohort included 300 patients aged 70 years or older scheduled for major surgery. The second included 919 medical patients aged 70 years or older. MEASUREMENTS: A 4-item short form and a 10-item long form were developed. Association of the maximum CAM-S score during hospitalization with hospital and posthospital outcomes related to delirium was evaluated. RESULTS: Representative results included adjusted mean length of stay, which increased across levels of short-form severity from 6.5 days (95% CI, 6.2 to 6.9 days) to 12.7 days (CI, 11.2 to 14.3 days) (P for trend < 0.001) and across levels of long-form severity from 5.6 days (CI, 5.1 to 6.1 days) to 11.9 days (CI, 10.8 to 12.9 days) (P for trend < 0.001). Representative results for the composite outcome of adjusted relative risk of death or nursing home residence at 90 days increased progressively across levels of short-form severity from 1.0 (referent) to 2.5 (CI, 1.9 to 3.3) (P for trend < 0.001) and across levels of long-form severity from 1.0 (referent) to 2.5 (CI, 1.6 to 3.7) (P for trend < 0.001). LIMITATION: Data on clinical outcomes were measured in an older data set limited to patients aged 70 years or older. CONCLUSION: The CAM-S provides a new delirium severity measure with strong psychometric properties and strong associations with important clinical outcomes. PRIMARY FUNDING SOURCE: National Institute on Aging.
BACKGROUND: Quantifying the severity of delirium is essential to advancing clinical care by improved understanding of delirium effect, prognosis, pathophysiology, and response to treatment. OBJECTIVE: To develop and validate a new delirium severity measure (CAM-S) based on the Confusion Assessment Method. DESIGN: Validation analysis in 2 independent cohorts. SETTING: Three academic medical centers. PATIENTS: The first cohort included 300 patients aged 70 years or older scheduled for major surgery. The second included 919 medical patients aged 70 years or older. MEASUREMENTS: A 4-item short form and a 10-item long form were developed. Association of the maximum CAM-S score during hospitalization with hospital and posthospital outcomes related to delirium was evaluated. RESULTS: Representative results included adjusted mean length of stay, which increased across levels of short-form severity from 6.5 days (95% CI, 6.2 to 6.9 days) to 12.7 days (CI, 11.2 to 14.3 days) (P for trend &lt; 0.001) and across levels of long-form severity from 5.6 days (CI, 5.1 to 6.1 days) to 11.9 days (CI, 10.8 to 12.9 days) (P for trend &lt; 0.001). Representative results for the composite outcome of adjusted relative risk of death or nursing home residence at 90 days increased progressively across levels of short-form severity from 1.0 (referent) to 2.5 (CI, 1.9 to 3.3) (P for trend &lt; 0.001) and across levels of long-form severity from 1.0 (referent) to 2.5 (CI, 1.6 to 3.7) (P for trend &lt; 0.001). LIMITATION: Data on clinical outcomes were measured in an older data set limited to patients aged 70 years or older. CONCLUSION: The CAM-S provides a new delirium severity measure with strong psychometric properties and strong associations with important clinical outcomes. PRIMARY FUNDING SOURCE: National Institute on Aging.
Authors: Eva M Schmitt; Edward R Marcantonio; David C Alsop; Richard N Jones; Selwyn O Rogers; Tamara G Fong; Eran Metzger; Sharon K Inouye Journal: J Am Med Dir Assoc Date: 2012-09-19 Impact factor: 4.669
Authors: K Milisen; M D Foreman; I L Abraham; S De Geest; J Godderis; E Vandermeulen; B Fischler; H H Delooz; B Spiessens; P L Broos Journal: J Am Geriatr Soc Date: 2001-05 Impact factor: 5.562
Authors: Joost Witlox; Lisa S M Eurelings; Jos F M de Jonghe; Kees J Kalisvaart; Piet Eikelenboom; Willem A van Gool Journal: JAMA Date: 2010-07-28 Impact factor: 56.272
Authors: Kenneth E Covinsky; Robert M Palmer; Richard H Fortinsky; Steven R Counsell; Anita L Stewart; Denise Kresevic; Christopher J Burant; C Seth Landefeld Journal: J Am Geriatr Soc Date: 2003-04 Impact factor: 5.562
Authors: Babar A Khan; Anthony J Perkins; Sujuan Gao; Siu L Hui; Noll L Campbell; Mark O Farber; Linda L Chlan; Malaz A Boustani Journal: Crit Care Med Date: 2017-05 Impact factor: 7.598
Authors: Sarinnapha M Vasunilashorn; Dena Schulman-Green; Douglas Tommet; Tamara G Fong; Tammy T Hshieh; Edward R Marcantonio; Eran D Metzger; Eva M Schmitt; Patricia A Tabloski; Thomas G Travison; Yun Gou; Benjamin Helfand; Sharon K Inouye; Richard N Jones Journal: Dement Geriatr Cogn Disord Date: 2020-06-17 Impact factor: 2.959
Authors: Sarinnapha M Vasunilashorn; Long H Ngo; Sharon K Inouye; Tamara G Fong; Richard N Jones; Simon T Dillon; Towia A Libermann; Margaret O'Connor; Steven E Arnold; Zhongcong Xie; Edward R Marcantonio Journal: Alzheimers Dement Date: 2020-01-04 Impact factor: 21.566
Authors: C G Clemmesen; L M Pedersen; S Hougaard; M L Andersson; V Rosenkvist; H B Nielsen; H Palm; N B Foss Journal: J Clin Monit Comput Date: 2018-02-05 Impact factor: 2.502
Authors: Eric S Orman; Anthony Perkins; Marwan Ghabril; Babar A Khan; Naga Chalasani; Malaz A Boustani Journal: Metab Brain Dis Date: 2015-05-07 Impact factor: 3.584
Authors: Cyrus M Kosar; Patricia A Tabloski; Thomas G Travison; Richard N Jones; Eva M Schmitt; Margaret R Puelle; Jennifer B Inloes; Jane S Saczynski; Edward R Marcantonio; David Meagher; M Carrington Reid; Sharon K Inouye Journal: Lancet Psychiatry Date: 2014-11 Impact factor: 27.083
Authors: Tammy T Hshieh; Tamara G Fong; Eva M Schmitt; Edward R Marcantonio; Madeline L D'Aquila; Jacqueline Gallagher; Guoquan Xu; Yun R Guo; Tatiana F Abrantes; Sylvie E Bertrand; Richard N Jones; Sharon K Inouye Journal: Gerontology Date: 2018-07-20 Impact factor: 5.140
Authors: W Weinrebe; R Preda; S Bischoff; D Nussbickel; M Humm; K Jeckelmann; S Goetz Journal: Z Gerontol Geriatr Date: 2017-07-18 Impact factor: 1.281
Authors: Franchesca Arias; Fan Chen; Tamara G Fong; Haley Shiff; Margarita Alegria; Edward R Marcantonio; Yun Gou; Richard N Jones; Thomas G Travison; Eva M Schmitt; Amy J H Kind; Sharon K Inouye Journal: J Am Geriatr Soc Date: 2020-08-31 Impact factor: 5.562