ArticleBMJ open2018
Reliability and accuracy of delirium assessments among investigators at multiple international centres.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 37 citations in OpenAlex.
- Effectiveness of drug interventions to prevent delirium after surgery for older adults: systematic review and network meta-analysis of randomised controlled trials.BMJ (Clinical research ed.) · 2026Pooled it
- Delirium in neurosurgery: a systematic review and meta-analysis.Neurosurgical review · 2022Pooled it
- Feasibility of Alerting Systems and Family Care Partner Support for Postoperative Delirium Prevention.Journal of neurosurgical anesthesiology · 2025Trial
- Detection of postoperative delirium by family and caregivers: Evaluation of the family confusion assessment method (FAM-CAM).Journal of clinical anesthesia · 2025Trial
- Use of the confusion assessment method in multicentre delirium trials: training and standardisation.BMC geriatrics · 2019Trial
- Trial
- A bibliometric analysis on delirium in intensive care unit from 2013-2023.Frontiers in neurology · 2025Article
- Differences in Medication Use by Gender and Race in Hospitalized Persons Living with Dementia.Journal of racial and ethnic health disparities · 2024Article
- Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment.CNS neuroscience & therapeutics · 2022Review
- Testing Function Focused Care for Acute Care using the Evidence Integration Triangle: Protocol description.Research in nursing & health · 2022Article
- Association of electroencephalogram epileptiform discharges during cardiac surgery with postoperative delirium: An observational study.Frontiers in surgery · 2022Article
- Evaluation of the 3-Minute Diagnostic Confusion Assessment Method for Identification of Postoperative Delirium in Older Patients.JAMA network open · 2021Article
- Delirium and neuropsychological outcomes in critically Ill patients with COVID-19: a cohort study.BMJ open · 2021Article
- Article
- The Effect of Multiple Assessments on Delirium Detection: a Pilot Study.Canadian geriatrics journal : CGJ · 2020Article
- ICU Delirium-Prediction Models: A Systematic Review.Critical care explorations · 2020Article
- Electroencephalography-guided anaesthetic administration does not impact postoperative delirium among older adults undergoing major surgery: an independent discussion of the ENGAGES trial.British journal of anaesthesia · 2019Article
- Recommendations and Alerting for Delirium Alleviation in Real-Time (RADAR): Protocol for a pilot randomized controlled trial.F1000Research · 2019Article
- Protocol for the electroencephalography guidance of anesthesia to alleviate geriatric syndromes (ENGAGES-Canada) study: A pragmatic, randomized clinical trial.F1000Research · 2019Article
Corrections and comments
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Authors and funding
12 authors at 4 institutions in 1 country.
Funding
Abstract
introductionDelirium is a common, serious postoperative complication. For clinical studies to generate valid findings, delirium assessments must be standardised and administered accurately by independent researchers. The Confusion Assessment Method (CAM) is a widely used delirium assessment tool. The objective was to determine whether implementing a standardised CAM training protocol for researchers at multiple international sites yields reliable inter-rater assessment and accurate delirium diagnosis.
methodsPatients consented to video recordings of CAM delirium assessments for research purposes. Raters underwent structured training in CAM administration. Training entailed didactic education, role-playing with intensive feedback, apprenticeship with experienced researchers and group discussions of complex cases. Raters independently viewed and scored nine video-recorded CAM interviews. Inter-rater reliability was determined using Fleiss kappa. Accuracy was judged by comparing raters' scores with those of an expert delirium researcher.
resultsTwenty-seven raters from eight international research centres completed the study and achieved almost perfect agreement for overall delirium diagnosis, kappa=0.88 (95% CI 0.85 to 0.92). Agreement of the four core CAM features ranged from fair to substantial. The sensitivity and specificity for identifying delirium were 72% (95% CI 60% to 81%) and 99% (95% CI 96% to 100%), considering an expert rater's scores as the reference standard (delirious, n=3; non-delirious, n=6). Delirium severity ratings were tightly clustered, with most scores within 5% of the median.
conclusionOur results demonstrate that, with appropriate training and ongoing scoring discussions, researchers at multiple sites can reliably detect delirium in postsurgical patients. These results support the premise that methodologically rigorous multi-centre studies can yield standardised and accurate determinations of delirium.
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