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Open Access Highly Accessed Research article

Diagnosing delirium in elderly Thai patients: Utilization of the CAM algorithm

Nahathai Wongpakaran1*, Tinakon Wongpakaran1, Putipong Bookamana2, Manee Pinyopornpanish1, Benchalak Maneeton1, Peerasak Lerttrakarnnon3, Kasem Uttawichai3 and Surin Jiraniramai3

Author Affiliations

1 Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

2 Department of Statistics, Faculty of Sciences, Chiang Mai University, Chiang Mai, Thailand

3 Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

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BMC Family Practice 2011, 12:65  doi:10.1186/1471-2296-12-65

Published: 1 July 2011

Abstract

Background

Delirium is a common illness among elderly hospitalized patients. However, under-recognition of the condition by non-psychiatrically trained personnel is prevalent. This study investigated the performance of family physicians when detecting delirum in elderly hospitalized Thai patients using the Thai version of the Confusion Assessment Method (CAM) algorithm.

Methods

A Thai version of the CAM algorithm was developed, and three experienced Thai family physicians were trained in its use. The diagnosis of delirium was also carried out by four fully qualified psychiatrists using DSM-IV TR criteria, which can be considered the gold standard. Sixty-six elderly patients were assessed with MMSE Thai 2002, in order to evaluate whether they had dementia upon admission. Within three days of admission, each patient was interviewed separately by a psychiatrist using DSM-IV TR, and a family physician using the Thai version of the CAM algorithm, with both sets of interviewers diagnosing for delirium.

Results

The CAM algorithm tool, as used by family physicians, demonstrated a sensitivity of 91.9% and a specificity of 100.0%, with a PPV of 100.0% and an NPV of 90.6%. Interrater agreement between the family physicians and the psychiatrists was good (Cohen's Kappa = 0.91, p < 0.0001). The mean of the time the family physicians spent using CAM algorithm was significantly briefer than that of the psychiatrists using DSM-IV TR.

Conclusions

Family physicians performed well when diagnosing delirium in elderly hospitalized Thai patients using the Thai version of the CAM algorithm, showing that this measurement tool is suitable for use by non-psychiatrically trained personnel, being short, quick, and easy to administer. However, proper training on use of the algorithm is required.