The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts.
The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts.
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CAM-S：在2个队列中del妄严重性的新评分系统的开发和验证。
DOI：
10.7326/m13-1927
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发表时间：
2014-04-15
影响因子：
39.2
通讯作者：
Jones RN
中科院分区：
文献类型：
--
作者：
Inouye SK;Kosar CM;Tommet D;Schmitt EM;Puelle MR;Saczynski JS;Marcantonio ER;Jones RN
量化谵妄的严重程度对于通过改善对谵妄影响、预后、病理生理学和治疗反应的理解来推进临床护理至关重要。在两个独立队列中，基于混淆评估方法验证分析，开发并验证新的谵妄严重程度测量（CAM-S）。三个学术医学中心第一队列包括300例年龄≥ 70岁的计划接受大手术的患者;第二队列包括919例年龄≥ 70岁的住院患者。开发了4个项目的短表和10个项目的长表。评估住院期间最大CAM-S评分与谵妄相关的住院和住院后结局的相关性。CAM-S评分与所有临床结局均表现出强相关性，在校正分析中，严重程度类别之间存在显著梯度，仅对谵妄诊断有实质性影响。代表性结果包括校正的平均住院时间（LOS），其在CAM-S简表严重程度水平之间从6.5（95%置信区间，CI，6.2-6.9）增加到12.7天（95% CI，11.2-14.3）（P趋势< 0.001）。在CAM-S长型严重程度的增加水平之间的可比结果为5.6（95% CI，5.1-6.1）至11.9天（95% CI，10.8-12.9）（P趋势< 0.001）。在CAM-S简式严重程度的不同水平中，90天死亡或疗养院居住的校正相对风险的复合结局的代表性结果从1.0（参照）增加到2.5（95%CI，1.9-3.3）（P趋势< 0.001）。CAM-S长型严重程度的可比结果为1.0（参考）至2.5（95% CI，1.6-3.7）（P趋势< 0.001）。临床结局数据来自年龄≥ 70岁患者的旧数据集。CAM-S提供了一种新的谵妄严重程度测量方法，具有较强的心理测量特性，并与重要的临床结局密切相关。
Quantifying the severity of delirium is essential to advance clinical care through improved understanding of delirium impact, prognosis, pathophysiology, and response to treatment. To develop and validate a new delirium severity measure (CAM-S) based on the Confusion Assessment Method Validation analysis in two independent cohorts. Three academic medical centers First cohort included 300 patients age ≥ 70 years scheduled for major surgery; second included 919 medicine admissions age ≥ 70 years. A 4-item short form and 10-item long-form were developed. The association of the maximal CAM-S score during hospitalization with hospital and post-hospital outcomes related to delirium was evaluated. CAM-S scores demonstrated strong associations with all clinical outcomes examined, with significant gradients across severity categories in adjusted analyses, adding substantively to delirium diagnoses alone. Representative results included adjusted mean length of stay (LOS), which increased across levels of CAM-S short form severity from 6.5 (95% confidence interval, CI, 6.2-6.9) to 12.7 days (95% CI, 11.2-14.3)(Ptrend < 0.001). Comparable results across increasing levels of the CAM-S long form severity were 5.6 (95% CI, 5.1-6.1) to 11.9 days (95% CI, 10.8-12.9) (Ptrend < 0.001). Representative results for the composite outcome of adjusted relative risk of death or nursing home residence at 90 days increased across levels of CAM-S short form severity from 1.0 (referent) to 2.5 (95% CI, 1.9-3.3)(Ptrend < 0.001). Comparable results for the CAM-S long form severity were 1.0 (referent) to 2.5 (95% CI, 1.6-3.7) (Ptrend < 0.001). Data on clinical outcomes were drawn from an older dataset involving patients age 70 years and older. CAM-S provides a new delirium severity measure with strong psychometric properties and strong associations with important clinical outcomes.