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A quick and easy delirium assessment for nonphysician research personnel

  • Jin H. Han
    Correspondence
    Corresponding author at: Vanderbilt University Medical Center, Department of Emergency Medicine, 703 Oxford House, Nashville, Tennessee 37232-4700. Tel.: +1 615 936 0087; fax: +1 615 936 1316.
    Affiliations
    Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee

    Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee

    Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
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  • Amanda Wilson
    Affiliations
    Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee
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  • Amy J. Graves
    Affiliations
    Department of Urologic Society, Vanderbilt University Medical Center, Nashville, Tennessee
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  • Ayumi Shintani
    Affiliations
    Department of Clinical Epidemiology and Biostatistics, Osaka University, Osaka, Japan
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  • John F. Schnelle
    Affiliations
    Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee

    Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee

    Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee

    Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, Tennessee
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  • E. Wesley Ely
    Affiliations
    Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee

    Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee

    Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee

    Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, Tennessee
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Published:February 29, 2016DOI:https://doi.org/10.1016/j.ajem.2016.02.069

      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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