Validation of the Malay 3-Minute Diagnostic Interview for Confusion Assessment Method in a surgical population

Authors

  • Pui San Loh Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur
  • Yi Zhe Chin Department of Anaesthesiology and Intensive Care Unit, Sarawak General Hospital, Jalan Hospital, Kuching, Sarawak
  • Jia Wen Lee Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur
  • Angelvene Wong Psychiatry Department, Hospital Sibu, Sibu, Sarawak
  • Marzida Mansor Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur
  • Chong Guan Ng Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • David Cowan Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  • Matthew TV Chan Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
  • Chew Yin Wang Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur

DOI:

https://doi.org/10.54029/2021xfd

Keywords:

delirium, confusion assessment method, 3-minute diagnostic, 3D-CAM, Malay 3D CAM, validation

Abstract

Background: Delirium is a common postoperative complication among elderly which can be easily missed and leads to poorer outcomes. The 3-Minute Diagnostic Assessment for Confusion Assessment Method (3D-CAM) is a short and structured tool to assess delirium by healthcare staff with minimal training. This study aimed to validate the translated Malay 3D-CAM (M3D-CAM) in postoperative surgical patients.

Methods: In this prospective diagnostic study, 3D-CAM was translated into Malay and two assessors (1 and 2) independently interviewed surgical patients above 65 years old with M3D-CAM on postoperative day one. A psychiatrist diagnosed postoperative delirium according to the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) as the reference standard. The sequence of examinations was done randomly with all results blinded to each other and the diagnostic characteristics of M3D-CAM analysed with k coefficient used to evaluate reliability.

Results: A total of 427 patients were screened, 111 recruited with a final 100 paired interviews completed. Their mean age was 72 (± 6) years old. Two-thirds of patients were proficient in Malay and English, therefore assessed in both 3D-CAM and M3D-CAM. Delirium was identified in 11% and 12% of patients by assessors 1 and 2 respectively while compared to DSM-5, M3D-CAM had 80% and 90% sensitivity with 96.7% and 97.7% specificity. M3D-CAM had excellent inter-rater reliability (85%), substantial parallel reliability (70%) and features 1 and 3 with substantial parallel agreement (p <0.001).

Conclusion: This study demonstrated that M3D-CAM is reliable and valid for delirium assessment in the postoperative setting.

Published

2022-01-01

Issue

Vol. 26 No. 4 (2021)

Section

Original Article