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Validation study of the European Portuguese version of the Confusion Assessment Method (CAM)

Published online by Cambridge University Press:  02 October 2014

Sónia Martins ,
Carla Lourenço ,
João Pinto-de-Sousa ,
Filipe Conceição ,
José Artur Paiva ,
Mário R. Simões  and
Lia Fernandes
Sónia Martins
Affiliation:
Research and Education Unit on Aging/UNIFAI–University of Porto, Rua Jorge de Viterbo Ferreira, nº 228, 4050-313 Porto, Portugal
Carla Lourenço
Affiliation:
UCISU, Intensive Medicine Service, CHSJ, Porto. Al. Hernâni Monteiro, 4200-319 Porto, Portugal
João Pinto-de-Sousa
Affiliation:
Department of Surgery, Faculty of Medicine, University of Porto, Al. Hernâni Monteiro, 4200-319 Porto, Portugal
Filipe Conceição
Affiliation:
UCISU, Intensive Medicine Service, CHSJ, Porto. Al. Hernâni Monteiro, 4200-319 Porto, Portugal
José Artur Paiva
Affiliation:
Intensive Medicine and Emergency Autonomous Management Unit, CHSJ. Faculty of Medicine, University of Porto, Al. Hernâni Monteiro, 4200–319 Porto, Portugal
Mário R. Simões
Affiliation:
Psychological Assessment Laboratory. CINEICC. Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo. Apartado 6153, 3001-802 Coimbra, Portugal
Lia Fernandes*
Affiliation:
UNIFAI/CINTESIS Research Unit. Faculty of Medicine, University of Porto, Clinic of Psychiatry and Mental Health, CHSJ, Porto. Al. Hernâni Monteiro, 4200-319 Porto, Portugal
*
Correspondence should be addressed to: Lia Fernandes, Faculty of Medicine, University of Porto. Al. Hernâni Monteiro, 4200-319 Porto, Portugal. Phone: +00351222052525. Email: [email protected].
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Abstract

Background:

The Confusion Assessment Method (CAM) is the most widely used delirium screening instrument. The aim of this study was to evaluate the reliability and validity of the European Portuguese version of CAM.

Methods:

The sample included elderly patients (≥65 years), admitted for at least 48 h, into two intermediate care units (ICMU) of Intensive Medicine and Surgical Services in a university hospital. Exclusion criteria were: score ≤11 on the Glasgow Coma Scale (GCS), blindness/deafness, inability to communicate and to speak Portuguese. For concurrent validity, a blinded assessment was conducted by a psychiatrist (DSM-IV-TR, as a reference standard) and by a trained researcher (CAM). This instrument was also compared with other cognitive measures to evaluate convergent validity. Inter-rater reliability was also assessed.

Results:

In this sample (n = 208), 25% (n = 53) of the patients had delirium, according to DSM-IV-TR. Using this reference standard, the CAM had a moderate sensitivity of 79% and an excellent specificity of 99%. The positive predictive value was 95%, indicating a strong ability to confirm delirium with a positive test result, and the negative predictive value was lower (93%). Good convergent validity was also found, in particular with Mini-Mental State Examination (MMSE) (rs = −0.676; p ≤0.01) and Digit Span Test (DST) forward (rs = −0.605; p ≤0.01), as well as a high inter-rater reliability (diagnostic k = 1.00; single items’ k between 0.65 and 1.00).

Conclusion:

Robust results on concurrent and convergent validity and good reliability were achieved. This version was shown to be a valid and reliable instrument for delirium detection in elderly patients hospitalized in intermediate care units.

Keywords

deliriumagedconfusion assessment methodvalidation studysensitivity and specificityreliability
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 5 , May 2015 , pp. 777 - 784
Copyright
Copyright © International Psychogeriatric Association 2014 

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