A Tale of Two Methods: Chart and Interview Methods for Identifying Delirium

Objectives To compare chart‐ and interview‐based methods for identification of delirium. Design Prospective cohort study. Setting Two academic medical centers. Participants Individuals aged 70 and older undergoing major elective surgery (N = 300) (majority orthopedic surgery). Measurements Participa...

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Bibliographic Details
Published in:Journal of the American Geriatrics Society (JAGS) 2014-03, Vol.62 (3), p.518-524
Main Authors: Saczynski, Jane S., Kosar, Cyrus M., Xu, Guoquan, Puelle, Margaret R., Schmitt, Eva, Jones, Richard N., Marcantonio, Edward R., Wong, Bonnie, Isaza, Ilean, Inouye, Sharon K.
Format: Article
Language:English
Subjects:
Adult and adolescent clinical studies
Aged
Aged, 80 and over
Biological and medical sciences
Cohort Studies
Delirium
Delirium - diagnosis
Epidemiology
Female
General aspects
Hospitalization
Humans
Interview, Psychological - methods
Male
Medical Records
Medical sciences
methodology
Methods
Older people
Organic mental disorders. Neuropsychology
Prospective Studies
Psychological Tests
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Public health. Hygiene
Public health. Hygiene-occupational medicine
Reproducibility of Results
Severity of Illness Index
Surgery
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Summary:Objectives To compare chart‐ and interview‐based methods for identification of delirium. Design Prospective cohort study. Setting Two academic medical centers. Participants Individuals aged 70 and older undergoing major elective surgery (N = 300) (majority orthopedic surgery). Measurements Participants were interviewed daily during hospitalization for delirium using the Confusion Assessment Method (CAM; interview‐based method), and their medical charts were reviewed for delirium using a validated chart‐review method (chart‐based method). Rate of agreement of the two methods and characteristics of those identified using each approach were examined. Predictive validity for clinical outcomes (length of stay, postoperative complications, discharge disposition) was compared. In the absence of a criterion standard, predictive value could not be calculated. Results The cumulative incidence of delirium was 23% (n = 68) according to the interview‐based method, 12% (n = 35) according to the chart‐based method, and 27% (n = 82) according to the combined approach. Overall agreement was 80%; kappa was 0.30. The methods differed in detection of psychomotor features and time of onset. The chart‐based method missed delirium in individuals that the CAM identified who were lacking features of psychomotor agitation or inappropriate behavior. The CAM‐based method missed chart‐identified cases occurring during the night shift. The combined method had high predictive validity for all clinical outcomes. Conclusions Interview‐ and chart‐based methods have specific strengths for identification of delirium. A combined approach captures the largest number and broadest range of delirium cases.
ISSN:0002-8614
1532-5415
DOI:10.1111/jgs.12684