Detection of postoperative delirium by family and caregivers: Evaluation of the family confusion assessment method (FAM-CAM)

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-08-13 DOI:10.1016/j.jclinane.2025.111963

Angela M. Mickle MS , Bethany R. Tellor Pennington , Arbi Ben Abdallah PhD , Wei Wang PhD , Nan Lin PhD , Jordan Oberhaus BS , Thaddeus P. Budelier MD , Daniel Park BS , Ben J. Palanca MD, PhD , Troy S. Wildes MD , Eva M. Schmitt PhD , Sharon K. Inouye MD, MPH , Michael S. Avidan MBBCh

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引用次数: 0

Abstract

Objective

The primary objective was to evaluate agreement between researchers' and family members' postoperative delirium assessment. The secondary objective was to assess the incidence of positive FAM-CAM after hospital discharge up to 30-days postoperatively.

Methods

This was a pre-specified sub-study of two multicenter randomized controlled trials that evaluated interventions to prevent postoperative delirium in older adults undergoing major elective surgery. In the hospital, delirium was ascertained using the Confusion Assessment Method (CAM) long-form or the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), and structured chart review. Family members completed a Family Confusion Assessment Method (FAM-CAM) concurrent with researchers' assessments in the afternoons on postoperative days 1–3. At the time of hospital discharge, a booklet of FAM-CAM surveys was provided to complete daily until postoperative day 30. Agreement between researcher-rated CAM/CAM-ICU and family-rated FAM-CAM was analyzed using Generalized Linear Mixed Model with repeated measures, and Bland-Altman analysis. Inter-rater reliability for each instrument was modeled using intraclass correlation coefficient (ICC). Overall agreement beyond chance between researcher's assessment and the FAM-CAM was evaluated using repeated measure Cohen's Kappa and sensitivity, specificity, and positive and negative predicted values. Post-discharge FAM-CAM data were summarized descriptively.

Results

A total of 817 patients had 1349 concurrent delirium assessments. Postoperative delirium incidence by researchers' assessment was 18.8 % and detection of delirium symptoms by FAM-CAM was 22.4 %. Analysis comparing delirium assessments showed there is an observed agreement beyond chance of 79.7 % with a kappa of 0.33 between the assessments by Generalized Linear Mixed Modeling with repeated measures, treating patients and raters as random effects, with FAM-CAM being more likely to report a positive delirium outcome. Assessment by features showed similar results. Both methods had an excellent degree of internal validity (CAM/CAM-ICU intraclass correlation =0.938, FAM-CAM intraclass correlation = 0.985). Repeated measures Cohen's kappa indicated good overall agreement (kappa = 0.72 [95 % confidence interval, 0.63 to 0.81]). Of the 330 booklets, 133 (40.3 %) were returned. A total of 18 patients exhibited symptoms indicative of delirium based on the FAM-CAM assessment between hospital discharge and 30 days postoperatively. Out of these, 9 (50 %) had also been diagnosed with postoperative delirium during their hospitalization.

Conclusion

This study demonstrated that family member completed FAM-CAM had acceptable agreement with researchers' delirium assessments. Postoperative delirium symptoms were detected more frequently by family-administered FAM-CAM compared to delirium incidence identified by researcher assessments. Family members identified that some patients experienced delirium symptoms after hospital discharge.

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家庭及护理人员对术后谵妄的检测：家庭困惑评估法（FAM-CAM）的评价

目的评价研究人员和家属术后谵妄评估的一致性。次要目的是评估术后30天出院后FAM-CAM阳性的发生率。方法：这是一项预先指定的两项多中心随机对照试验的亚研究，评估干预措施预防老年人接受重大择期手术后谵妄。在医院，谵妄的诊断采用神志不清评估法（CAM）长格式或重症监护病房神志不清评估法（CAM- icu），并进行结构化图表复习。在术后第1-3天的下午，患者家属在接受研究人员评估的同时完成了家庭困惑评估法（FAM-CAM）。出院时，每天提供一份FAM-CAM调查手册，直至术后第30天。采用重复测量的广义线性混合模型和Bland-Altman分析，分析研究者评价的CAM/CAM- icu与家庭评价的FAM-CAM之间的一致性。使用类内相关系数（ICC）对每种仪器的等级间信度进行建模。研究者的评估与FAM-CAM之间的总体一致性通过重复测量Cohen’s Kappa和敏感性、特异性、阳性和阴性预测值进行评估。对出院后FAM-CAM数据进行描述性总结。结果817例患者共进行1349次谵妄评估。研究者评估的术后谵妄发生率为18.8%，FAM-CAM检测谵妄症状的发生率为22.4%。比较谵妄评估的分析显示，通过重复测量的广义线性混合模型评估之间的一致性超过79.7%，kappa为0.33，将患者和评分者视为随机效应，FAM-CAM更有可能报告积极的谵妄结果。特征评价结果相似。两种方法均具有良好的内效度（CAM/CAM- icu类内相关=0.938，FAM-CAM类内相关= 0.985）。重复测量Cohen’s kappa表明总体一致性良好（kappa = 0.72[95%置信区间，0.63 ~ 0.81]）。在330本小册子中，133本（40.3%）被归还。根据FAM-CAM评估，出院至术后30天共有18例患者表现出谵妄症状。其中，9例（50%）在住院期间也被诊断为术后谵妄。结论本研究表明完成FAM-CAM的家庭成员与研究者的谵妄评估有可接受的一致性。与研究者评估确定的谵妄发生率相比，通过家庭管理的FAM-CAM检测到术后谵妄症状的频率更高。家属确认一些患者出院后出现谵妄症状。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.