Abstract
Objectives
Delirium in the emergency department (ED) is an emerging field of research. Most ED
research infrastructures utilize lay personnel to collect data, but delirium assessments
that can be reliably performed by nonphysicians are lacking. We evaluated the diagnostic
performance of the modified Brief Confusion Assessment Method (modified bCAM) for
this purpose.
Methods
This was a secondary analysis of a prospective observational study that enrolled ED
patients 65 years or older. The original bCAM was a brief (<2 minutes) delirium assessment that assessed for inattention by asking the patient to
recite the months backward from December to July. It was modified by adding the Vigilance
A (“squeeze my hand when you hear the letter ‘A’”) to the inattention assessment.
The elements of the modified bCAM were performed by a research assistant (RA) and
emergency physician. The reference standard for delirium was a psychiatrist assessment
performed within 3 hours using Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition, Text Revision criteria. All assessors were blinded to each other. Sensitivities and specificities
with their 95% confidence intervals (CIs) were calculated for the RA and emergency
physician.
Results
Of the 406 patients enrolled, 50 (12%) were delirious. The modified bCAM was 82.0%
(95% CI, 71.4%-92.6%) sensitive and 96.1% (95% CI, 94.0%-98.1%) specific when performed
by the RA. The emergency physician's modified bCAM exhibited similar diagnostic performance.
Conclusions
The modified bCAM may be a feasible and accurate method for nonphysicians to assess
for delirium. Future studies are needed to confirm these findings.
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Article Info
Publication History
Published online: February 29, 2016
Accepted:
February 25,
2016
Received in revised form:
January 28,
2016
Received:
December 21,
2015
Footnotes
☆Source of funding: Dr Han and this study were funded by the Emergency Medicine Foundation Career Development Award and the National Institutes of Health ( K23AG032355 ). This study was also supported by the National Center for Research Resources (grant UL1 RR024975-01 ) and is now at the National Center for Advancing Translational Sciences (grant 2 UL1 TR000445-06 ). Dr Ely was supported in part by the National Institutes of Health R01AG027472 and R01AG035117 , and a Veteran Affairs MERIT award and Geriatric Research, Education, and Clinical Center. Dr Schnelle is also supported by the Veteran Affairs Geriatric Research, Education, and Clinical Center.
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