Identifying Indicators of Important Diagnostic Features of Delirium

Authors

  • Li-Wen Huang AB,

    1. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
    2. School of Medicine, Duke University, Durham, North Carolina
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    • Both authors contributed equally to this manuscript.
  • Sharon K. Inouye MD, MPH,

    1. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
    2. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    3. Harvard Medical School, Boston, Massachusetts
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    • Both authors contributed equally to this manuscript.
  • Richard N. Jones ScD,

    1. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
    2. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    3. Harvard Medical School, Boston, Massachusetts
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  • Tamara G. Fong MD, PhD,

    1. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
    2. Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    3. Harvard Medical School, Boston, Massachusetts
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  • James L. Rudolph MD, MS,

    1. Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
    2. Harvard Medical School, Boston, Massachusetts
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  • Margaret G. O'Connor PhD,

    1. Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    2. Harvard Medical School, Boston, Massachusetts
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  • Eran D. Metzger MD,

    1. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
    2. Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    3. Harvard Medical School, Boston, Massachusetts
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  • Paul K. Crane MD, MPH,

    1. Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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  • Edward R. Marcantonio MD, MS

    Corresponding author
    1. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    2. Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    3. Harvard Medical School, Boston, Massachusetts
    • Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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Address correspondence to Edward R. Marcantonio, Section Chief for Research, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue CO-216, Boston, MA 02215. E-mail: emarcant@bidmc.harvard.edu

Abstract

Objectives

To use an expert consensus process to identify indicators of delirium features to help enhance bedside recognition of delirium.

Design

Modified Delphi consensus process to assign existing cognitive and delirium assessment items to delirium features in the Confusion Assessment Method (CAM) diagnostic algorithm.

Setting

Meetings of expert panel.

Participants

Panel of seven interdisciplinary clinical experts.

Measurements

Panelists' assignments of each assessment item to indicate CAM features.

Results

From an initial pool of 119 assessment items, the panel assigned 66 items to at least one CAM feature, and many items were assigned to more than one feature. Experts achieved a high level of consensus, with a postmeeting kappa for agreement of 0.98. The study staff compiled the assignment results to create a comprehensive list of CAM feature indicators, consisting of 107 patient interview questions, cognitive tasks, and interviewer observations, with some items assigned to multiple features. A subpanel shortened this list to 28 indicators of important delirium features.

Conclusion

A systematic, well-described qualitative methodology was used to create a list of indicators for delirium based on the features of the CAM diagnostic algorithm. This indicator list may be useful as a clinical tool for enhancing delirium recognition at the bedside and for aiding in the development of a brief delirium screening instrument.

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