Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy

被引:104
作者
Shi, Qiyun [1 ,2 ]
Warren, Laura [3 ]
Saposnik, Gustavo [2 ]
MacDermid, Joy C. [1 ]
机构
[1] Univ Western Ontario, Elborn Coll, London, ON N6G 1H1, Canada
[2] Univ Toronto, St Michaels Hosp, Dept Med, Stroke Outcomes Res Ctr, Toronto, ON M5B 1W8, Canada
[3] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada
关键词
confusion assessment method; diagnostic accuracy; delirium; systematic review; meta-analysis; INTENSIVE-CARE-UNIT; DELIRIUM SCREENING CHECKLIST; 3; SCORES; VALIDATION; CAM; RELIABILITY; VALIDITY; TOOLS; SCALE; TRANSLATION;
D O I
10.2147/NDT.S49520
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Delirium is common in the early stages of hospitalization for a variety of acute and chronic diseases. Objectives: To evaluate the diagnostic accuracy of two delirium screening tools, the Confusion Assessment Method (CAM) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Methods: We searched MEDLINE, EMBASE, and PsychInfo for relevant articles published in English up to March 2013. We compared two screening tools to Diagnostic and Statistical Manual of Mental Disorders IV criteria. Two reviewers independently assessed studies to determine their eligibility, validity, and quality. Sensitivity and specificity were calculated using a bivariate model. Results: Twenty-two studies (n = 2,442 patients) met the inclusion criteria. All studies demonstrated that these two scales can be administered within ten minutes, by trained clinical or research staff. The pooled sensitivities and specificity for CAM were 82% (95% confidence interval [CI]: 69%-91%) and 99% (95% CI: 87%-100%), and 81% (95% CI: 57%-93%) and 98% (95% CI: 86%-100%) for CAM-ICU, respectively. Conclusion: Both CAM and CAM-ICU are validated instruments for the diagnosis of delirium in a variety of medical settings. However, CAM and CAM-ICU both present higher specificity than sensitivity. Therefore, the use of these tools should not replace clinical judgment.
引用
收藏
页码:1359 / 1370
页数:12
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