Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-19T15:14:59.587Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of the brief Confusion Assessment Method in a veteran palliative care population: A pilot validation study

Published online by Cambridge University Press:  19 March 2019

Jo Ellen Wilson ,
Leanne Boehm Open the ORCID record for Leanne Boehm [Opens in a new window] ,
Lauren R. Samuels Open the ORCID record for Lauren R. Samuels [Opens in a new window] ,
Deborah Unger ,
Martha Leonard ,
Christianne Roumie ,
E. Wesley Ely ,
Robert S. Dittus ,
Sumi Misra  and
Jin H. Han
Jo Ellen Wilson*
Affiliation:
Geriatric Research, Education and Clinical Center, Veterans Affairs TN Valley Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center Vanderbilt Center for Critical Illness, Brain Dysfunction, and Survivorship
Leanne Boehm
Affiliation:
Geriatric Research, Education and Clinical Center, Veterans Affairs TN Valley Vanderbilt Center for Critical Illness, Brain Dysfunction, and Survivorship Vanderbilt University School of Nursing
Lauren R. Samuels
Affiliation:
Geriatric Research, Education and Clinical Center, Veterans Affairs TN Valley Department of Biostatistics, Vanderbilt University Medical Center
Deborah Unger
Affiliation:
Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center Palliative Care Consultation Service, Veterans Affairs TN Valley
Martha Leonard
Affiliation:
Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center Palliative Care Consultation Service, Veterans Affairs TN Valley
Christianne Roumie
Affiliation:
Geriatric Research, Education and Clinical Center, Veterans Affairs TN Valley Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center
E. Wesley Ely
Affiliation:
Geriatric Research, Education and Clinical Center, Veterans Affairs TN Valley Vanderbilt Center for Critical Illness, Brain Dysfunction, and Survivorship Department of Medicine, Division of Pulmonary and Critical Care, and the Center for Health Services Research and Center for Quality Aging, Vanderbilt University Medical Center
Robert S. Dittus
Affiliation:
Geriatric Research, Education and Clinical Center, Veterans Affairs TN Valley Vanderbilt Center for Critical Illness, Brain Dysfunction, and Survivorship Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center
Sumi Misra
Affiliation:
Geriatric Research, Education and Clinical Center, Veterans Affairs TN Valley Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center Palliative Care Consultation Service, Veterans Affairs TN Valley
Jin H. Han
Affiliation:
Geriatric Research, Education and Clinical Center, Veterans Affairs TN Valley Vanderbilt Center for Critical Illness, Brain Dysfunction, and Survivorship Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
*
Author for correspondence: Jo Ellen Wilson, The Vanderbilt Psychiatric Hospital, 1601 23rd Avenue South, Nashville, TN 37212. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Many patients with advanced serious illness or at the end of life experience delirium, a potentially reversible form of acute brain dysfunction, which may impair ability to participate in medical decision-making and to engage with their loved ones. Screening for delirium provides an opportunity to address modifiable causes. Unfortunately, delirium remains underrecognized. The main objective of this pilot was to validate the brief Confusion Assessment Method (bCAM), a two-minute delirium-screening tool, in a veteran palliative care sample.

Method

This was a pilot prospective, observational study that included hospitalized patients evaluated by the palliative care service at a single Veterans’ Administration Medical Center. The bCAM was compared against the reference standard, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Both assessments were blinded and conducted within 30 minutes of each other.

Result

We enrolled 36 patients who were a median of 67 years (interquartile range 63–73). The primary reasons for admission to the hospital were sepsis or severe infection (33%), severe cardiac disease (including heart failure, cardiogenic shock, and myocardial infarction) (17%), or gastrointestinal/liver disease (17%). The bCAM performed well against the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, for detecting delirium, with a sensitivity (95% confidence interval) of 0.80 (0.4, 0.96) and specificity of 0.87 (0.67, 0.96).

Significance of Results

Delirium was present in 27% of patients enrolled and never recognized by the palliative care service in routine clinical care. The bCAM provided good sensitivity and specificity in a pilot of palliative care patients, providing a method for nonpsychiatrically trained personnel to detect delirium.

Keywords

cognitiondeliriumpalliative careend-of-lifescreening
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 5 , October 2019 , pp. 569 - 573
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5). Washington, DC: American Psychiatric Publishing.Google Scholar
Close, JF and Long, CO (2012) Delirium: Opportunity for comfort in palliative care. Journal of Hospice & Palliative Nursing 14(6), 386–394.Google Scholar
Ely, EW, Gautam, S, Margolin, R, Francis, J, et al. (2001) The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Medicine 27(12), 1892–1900.Google Scholar
Ely, EW, Shintani, A, Truman, B, et al. (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291(14), 1753–1762.Google Scholar
Girard, TD, Jackson, JC, Pandharipande, PP, et al. (2010) Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Critical Care Medicine 38(7), 1513–1520.Google Scholar
Grassi, L, Caraceni, A, Beltrami, E, et al. (2001) Assessing delirium in cancer patients: The Italian versions of the Delirium Rating Scale and the Memorial Delirium Assessment Scale. Journal of Pain Symptom Management 21(1), 59–68.Google Scholar
Han, JH, Wilson, A, Vasilevskis, EE, et al. (2013) Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method. Annals of Emergency Medicine 62(5), 457–465.Google Scholar
Hosie, A, Davidson, PM, Agar, M, et al. (2013) Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: a systematic review. Palliative Medicine 27(6), 486–498.Google Scholar
Lat, I, McMillian, W, Taylor, S, et al. (2009) The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients. Critical Care Medicine 37(6), 1898–1905.Google Scholar
Lawlor, PG, Davis, DH, Ansari, M, et al. (2014) An analytical framework for delirium research in palliative care settings: Integrated epidemiologic, clinician-researcher, and knowledge user perspectives. Journal of Pain Symptom Management 48(2), 159–175.Google Scholar
Leonard, MM, Nekolaichuk, C, Meagher, DJ, et al. B (2014) Practical assessment of delirium in palliative care. Journal of Pain Symptom Management 48(2), 176–190.Google Scholar
Lumley, T (2004) Survey: Analysis of complex survey samples. Journal of Statistical Software 9(1), 1–19.Google Scholar
Milbrandt, EB, Deppen, S, Harrison, PL, et al. (2004) Costs associated with delirium in mechanically ventilated patients. Critical Care Medicine 32(4), 955–962.Google Scholar
Neufeld, KJ, Hayat, MJ, Coughlin, JM, et al. (2011) Evaluation of two intensive care delirium screening tools for non-critically ill hospitalized patients. Psychosomatics 52(2), 133–140.Google Scholar
Pandharipande, PP, Girard, TD, Jackson, JC, et al. (2013) Delirium as an independent predictor of long-term cognitive impairment: Results from the BRAIN ICU (Bringing to light the risk factors and incidence of neuropsychological dysfunction in ICU survivors) study. American Journal of Respiratory and Critical Care Medicine 187, A5237.Google Scholar
Ryan, K, Leonard, M, Guerin, S, et al. (2009) Validation of the confusion assessment method in the palliative care setting. Palliative Medicine 23(1), 40–45.Google Scholar
Shehabi, Y, Riker, RR, Bokesch, PM, et al. (2010) Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients. Critical Care Medicine 38(12), 2311–2318.Google Scholar
Witlox, J, Eurelings, LS, de Jonghe, JF, et al. (2010) Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: A meta-analysis. JAMA 304(4), 443–451.Google Scholar