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Article
The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts
University of Massachusetts Medical School Faculty Publications
  • Sharon K. Inouye, Hebrew SeniorLife
  • Cyrus Kosar, Hebrew SeniorLife
  • Douglas Tommet, Butler Hospital
  • Eva Schmitt, Hebrew SeniorLife
  • Margaret R. Puelle, Institute for Aging Research
  • Jane S. Saczynski, University of Massachusetts Medical School
  • Edward R. Marcantonio, Harvard Medical School
  • Richard N. Jones, Butler Hospital
UMMS Affiliation
Department of Medicine, Division of Geriatric Medicine; Meyers Primary Care Institute
Publication Date
4-15-2014
Document Type
Article
Subjects
Activities of Daily Living; Aged; Aged, 80 and over; Cognition Disorders; Delirium; Female; Hospital Costs; Humans; Length of Stay; Male; Nursing Homes; *Psychological Tests; Psychometrics; Severity of Illness Index
Abstract
BACKGROUND: Quantifying the severity of delirium is essential to advancing clinical care by improved understanding of delirium effect, prognosis, pathophysiology, and response to treatment. OBJECTIVE: To develop and validate a new delirium severity measure (CAM-S) based on the Confusion Assessment Method. DESIGN: Validation analysis in 2 independent cohorts. SETTING: Three academic medical centers. PATIENTS: The first cohort included 300 patients aged 70 years or older scheduled for major surgery. The second included 919 medical patients aged 70 years or older. MEASUREMENTS: A 4-item short form and a 10-item long form were developed. Association of the maximum CAM-S score during hospitalization with hospital and posthospital outcomes related to delirium was evaluated. RESULTS: Representative results included adjusted mean length of stay, which increased across levels of short-form severity from 6.5 days (95% CI, 6.2 to 6.9 days) to 12.7 days (CI, 11.2 to 14.3 days) (P for trend and < 0.001) and across levels of long-form severity from 5.6 days (CI, 5.1 to 6.1 days) to 11.9 days (CI, 10.8 to 12.9 days) (P for trend andlt; 0.001). Representative results for the composite outcome of adjusted relative risk of death or nursing home residence at 90 days increased progressively across levels of short-form severity from 1.0 (referent) to 2.5 (CI, 1.9 to 3.3) (P for trend andlt; 0.001) and across levels of long-form severity from 1.0 (referent) to 2.5 (CI, 1.6 to 3.7) (P for trend and < 0.001). LIMITATION: Data on clinical outcomes were measured in an older data set limited to patients aged 70 years or older. CONCLUSION: The CAM-S provides a new delirium severity measure with strong psychometric properties and strong associations with important clinical outcomes. PRIMARY FUNDING SOURCE: National Institute on Aging.
Rights and Permissions
Citation: Ann Intern Med. 2014 Apr 15;160(8):526-33. doi: 10.7326/M13-1927. Link to article on publisher's site
Related Resources
Link to Article in PubMed
PubMed ID
24733193
Citation Information
Sharon K. Inouye, Cyrus Kosar, Douglas Tommet, Eva Schmitt, et al.. "The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts" Vol. 160 Iss. 8 (2014) ISSN: 0003-4819 (Linking)
Available at: http://works.bepress.com/jane_saczynski/78/