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

Qiyun Shi,1,2 Laura Warren,3 Gustavo Saposnik,2 Joy C MacDermid1 1Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; 2Stroke Outcomes Research Center, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; 3Dalla Lana Sch...

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Autores principales:	Shi Q, Warren L, Saposnik G, MacDermid JC
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/69a46f4261a74c2494de0831e3abaf5a
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spelling	oai:doaj.org-article:69a46f4261a74c2494de0831e3abaf5a2021-12-02T06:23:29ZConfusion assessment method: a systematic review and meta-analysis of diagnostic accuracy1176-63281178-2021https://doaj.org/article/69a46f4261a74c2494de0831e3abaf5a2013-09-01T00:00:00Zhttp://www.dovepress.com/confusion-assessment-method-a-systematic-review-and-meta-analysis-of-d-a14409https://doaj.org/toc/1176-6328https://doaj.org/toc/1178-2021Qiyun Shi,1,2 Laura Warren,3 Gustavo Saposnik,2 Joy C MacDermid1 1Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; 2Stroke Outcomes Research Center, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; 3Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada 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. Keywords: confusion assessment method, diagnostic accuracy, delirium, systematic review, meta-analysisShi QWarren LSaposnik GMacDermid JCDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2013, Iss default, Pp 1359-1370 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Shi Q Warren L Saposnik G MacDermid JC Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy
description	Qiyun Shi,1,2 Laura Warren,3 Gustavo Saposnik,2 Joy C MacDermid1 1Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; 2Stroke Outcomes Research Center, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; 3Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada 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. Keywords: confusion assessment method, diagnostic accuracy, delirium, systematic review, meta-analysis
format	article
author	Shi Q Warren L Saposnik G MacDermid JC
author_facet	Shi Q Warren L Saposnik G MacDermid JC
author_sort	Shi Q
title	Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy
title_short	Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy
title_full	Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy
title_fullStr	Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy
title_full_unstemmed	Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy
title_sort	confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/69a46f4261a74c2494de0831e3abaf5a
work_keys_str_mv	AT shiq confusionassessmentmethodasystematicreviewandmetaanalysisofdiagnosticaccuracy AT warrenl confusionassessmentmethodasystematicreviewandmetaanalysisofdiagnosticaccuracy AT saposnikg confusionassessmentmethodasystematicreviewandmetaanalysisofdiagnosticaccuracy AT macdermidjc confusionassessmentmethodasystematicreviewandmetaanalysisofdiagnosticaccuracy
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Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy

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