Rivera Cameron, Kunkel David, Her Maihlee, Qureshi Simran, Pearce Robert A, Sanders Robert D, Lennertz Richard
Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA.
Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
BJA Open. 2025 Apr 21;14:100398. doi: 10.1016/j.bjao.2025.100398. eCollection 2025 Jun.
Several methods are used to measure delirium severity in the postoperative period. Here, we compare severity scores from two common assessment methods: the 3-Minute Diagnostic Confusion Assessment Method (3D-CAM) and the Delirium Rating Scale-Revised-98 (DRS).
Data were collected as part of an ongoing observational cohort study of perioperative delirium in patients >65 yr old undergoing major elective surgery with an anticipated hospital stay of at least 2 days. Patients were excluded if they had a documented history of dementia, resided in a nursing home, underwent neurosurgery, or could not complete neurocognitive testing. Patients underwent paired 3D-CAM and DRS assessments before and after operation along with EEG, cognitive testing, and plasma biomarker analysis.
Of 226 subjects enrolled, 204 completed both the 3D-CAM and DRS assessments. Peak 3D-CAM severity (3D-CAM-S) scores correlated with peak DRS severity scores, for both the raw (ρ=0.74, <0.001) and short form method (ρ=0.66, <0.001). Peak 3D-CAM-S raw scores also correlated with delirium duration and severity duration area under the curve measures (ρ=0.71, <0.001 and ρ=0.91, <0.001, respectively). Similar to prior reports with the DRS, 3D-CAM-S raw scores correlated with worse performance on the Trail Making Test B (ρ=0.37, <0.001, =177), slow-wave electroencephalogram power (ρ=0.3, =0.001, =73), and plasma neurofilament light (ρ=0.26, <0.05, =61) and tau (ρ=0.41, <0.001, =63).
The 3D-CAM-S severity scores correlated with DRS, delirium duration, and biomarkers of delirium. The 3D-CAM, which is easier to implement than the DRS in postoperative patients, may provide a comparable assessment of delirium severity in this population.
NCT03124303.
有多种方法用于测量术后谵妄的严重程度。在此，我们比较两种常用评估方法的严重程度评分：3分钟诊断性意识模糊评估法（3D - CAM）和谵妄评定量表修订版98（DRS）。
数据收集于一项正在进行的对年龄>65岁、接受择期大手术且预计住院至少2天的患者围手术期谵妄的观察性队列研究。如果患者有痴呆病史记录、居住在养老院、接受神经外科手术或无法完成神经认知测试，则将其排除。患者在手术前后接受了配对的3D - CAM和DRS评估，同时进行了脑电图、认知测试和血浆生物标志物分析。
在纳入的226名受试者中，204名完成了3D - CAM和DRS评估。3D - CAM严重程度峰值（3D - CAM - S）评分与DRS严重程度峰值评分相关，原始评分（ρ = 0.74，<0.001）和简表评分（ρ = 0.66，<0.001）均如此。3D - CAM - S原始峰值评分还与谵妄持续时间和曲线下面积测量的严重程度持续时间相关（分别为ρ = 0.71，<0.001和ρ = 0.91，<0.001）。与先前关于DRS的报告类似，3D - CAM - S原始评分与连线测验B表现较差（ρ = 0.37，<0.001，n = 177）、慢波脑电图功率（ρ = 0.3，= 0.001，n = 73）以及血浆神经丝轻链（ρ = 0.26，<0.05，n = 61）和tau蛋白（ρ = 0.41，<0.001，n = 63）相关。
3D - CAM - S严重程度评分与DRS、谵妄持续时间和谵妄生物标志物相关。在术后患者中，3D - CAM比DRS更易于实施，可能为该人群的谵妄严重程度提供可比的评估。
NCT03124303。
