The Reliability and Validity of the Chinese Version of Confusion Assessment Method Based Scoring System for Delirium Severity (CAM-S)

Xinchun Mei; Yupeng Chen; Hailin Zheng; Zhongyong Shi; Edward R Marcantonio; Zhongcong Xie; Yuan Shen

doi:10.3233/JAD-181288

The Reliability and Validity of the Chinese Version of Confusion Assessment Method Based Scoring System for Delirium Severity (CAM-S)

J Alzheimers Dis. 2019;69(3):709-716. doi: 10.3233/JAD-181288.

Authors

Xinchun Mei¹, Yupeng Chen¹, Hailin Zheng¹, Zhongyong Shi¹, Edward R Marcantonio², Zhongcong Xie³, Yuan Shen¹

Affiliations

¹ Department of Psychiatry, Shanghai 10th People's Hospital, Anesthesia and Brain Research Institute, Tongji University, Shanghai, China.
² Divisions of General Medicine and Primary Care and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
³ Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA.

Abstract

Previous studies showed that the Confusion Assessment Method based delirium severity evaluation tool (CAM-S) had good reliability and validity. However, there is no Chinese version of the CAM-S. Therefore, we set out to perform a prospective investigation in older Chinese patients who had total joint replacement surgery under general anesthesia in Tenth People's Hospital in Shanghai, P.R. China. A total of 576 participants, aged 60 years or older, were screened, 179 participants were enrolled, and 125 of them were included for the final analysis. Pre-operative evaluations were conducted one day before the surgery. Postoperative evaluations were conducted twice daily from postoperative day 1 to day 3. The incidence of postoperative delirium was 24.8%. The Chinese version of CAM-S [including a Short Form (CAM-S Short Form) and a Long Form (CAM-S Long Form)] had an optimal reliability reflected by internal consistency (Cronbach's α= 0.748 and 0.839 for CAM-S Short Form and CAM-S Long Form respectively), split-halves reliability (Pearson correlation coefficient = 0.372 and 0.384 for CAM-S Short Form and CAM-S Long Form respectively), and inter-rater reliability (intra-class correlation coefficients = 0.629 and 0.945 for CAM-S Short Form and CAM-S Long Form respectively). Additionally, the Chinese version of CAM-S also showed a good discriminate validity. The domain scores of CAM-S were inversely correlated with corresponding domain scores of the MMSE. Finally, a receiver operating characteristic (ROC) analysis obtained an optimal cutoff point of 2.5 for CAM-S Short Form and 3.5 for CAM-S Long Form in recognizing delirium diagnosed by CAM. The areas under the ROC were 0.989 (95% CI 0.972 - 1.000, p < 0.001) and 0.964 (95% CI 0.946 - 0.982, p < 0.001), respectively. These data suggest that the Chinese version of CAM-S has good reliability and validity in evaluating postoperative delirium in geriatric Chinese patients and may be a useful tool to assess the severity of delirium.

Keywords: Confusion assessment method; postoperative delirium severity; reliability; validity.

Publication types

Research Support, Non-U.S. Gov't
Validation Study

MeSH terms

Aged
Aged, 80 and over
Anesthesia, General
Arthroplasty, Replacement / adverse effects
Arthroplasty, Replacement / psychology
China
Confusion / diagnosis*
Confusion / psychology*
Delirium / diagnosis*
Delirium / psychology*
Female
Humans
Male
Middle Aged
Observer Variation
Postoperative Complications / diagnosis
Postoperative Complications / psychology
Prospective Studies
Reproducibility of Results
Severity of Illness Index
Translations

Grants and funding

K24 AG035075/AG/NIA NIH HHS/United States