Translation and cultural adaptation of the Greek version of the confusion assessment method diagnostic algorithm and the nursing delirium screening scale and their inter-rater reliability: A prospective cohort study

Abstract

Aim: The lack of standardized tools limits the diagnosis οf postoperative delirium (POD) in the Greek population. Our aim was the translation and the cultural adaptation of the confusion assessment method (CAM) diagnostic algorithm and the nursing delirium screening scale (nu-DESC) in the Greek surgical population, and the determination of their inter-rater reliability.

Methods: After Ethical approval and registration as a clinical trial (NCT04154176), a prospective cohort study was conducted in the Department of Anesthesiology, University Hospital of Larissa, Greece. Patients at least 60 years old, undergoing elective non-cardiac surgery, under general anesthesia were included.

Results: Data from 60 patients, 180 records in total, were analyzed. There was an "almost perfect agreement" between the raters with the use of CAM (Cohen's Kappa estimate: 0.960; 95 % CI: 0.905-1.000) and nu-DESC (Cohen's Kappa estimate: 0.981; 95 % CI: 0.944-1.000). The agreement on each specific question of CAM and nu-DESC ranged from "substantial" to "almost perfect agreement". Based on the CAM, the sensitivity and specificity of nu-DESC were 0.97 (95 % CI: 0.82-1.00) and 0.99 (95 % CI: 0.96-1.00), respectively. The Greek versions of CAM and nu-DESC showed a high inter-rater agreement.

Conclusion: With the translation, the cultural adaptation, and the determination of their inter-rater agreement, the CAM diagnostic algorithm and the nu-DESC may serve as reliable instruments for the detection of POD in the Greek population. HIPPOKRATIA 2020, 24(1): 8-14.

Keywords: Delirium; Greece; anesthesia; confusion assessment method; diagnosis; general; humans; neuropsychological tests; nursing delirium screening scale; reproducibility of results.

Figure 1. The translated and adapted Greek version of the confusion assessment method (CAM) diagnostic algorithm.

Figure 2. The translated and adapted Greek version of the nursing delirium screening scale (nu-DESC).

Figure 3. Flowchart depicting the patient sample selection.

Figure 4. A two-by-two graph visualizing the interaction plots between the two observers scores (mean values and 95 % confidence interval of the occurrence of postoperative delirium) and time for the confusion assessment method (CAM) diagnostic algorithm and the nursing delirium screening scale (nu-DESC). The scores were measured at 8, 16, and 22 hours after surgery; p values indicate the statistical significance among the repeated measurements. Accordingly, there was no statistically important change in the scores with time in our study sample.

Figure 5. Nursing delirium screening scale (nu-DESC) is an excellent tool in screening for postoperative delirium. The spider plot visualizes the accuracy of nu-DESC as a screening tool for delirium in postoperative patients based on the confusion assessment method (CAM) diagnostic algorithm as a gold standard. The inserts highlight the diagnostic accuracy analysis’s inherent details, including the area under the curve (AUC). Spec: specificity, Sens: sensitivity, Acc: accuracy, PPV: positive predictive value, NPV: negative predictive value.