The 3-Minute Diagnostic Confusion Assessment Method severity score correlates with the Delirium Rating Scale–Revised–98 and with biomarkers of delirium

• Published in: BJA open Vol. 14; p. 100398
• Main Authors: Rivera, Cameron, Kunkel, David, Her, Maihlee, Qureshi, Simran, Pearce, Robert A., Sanders, Robert D., Lennertz, Richard
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2025; Elsevier
• Subjects: 3D-CAM; biomarker; CAM; delirium; DRS; Original; postoperative; severity; surgery; postoperative; severity; DRS; 3D-CAM; biomarker; CAM; delirium; surgery
• ISSN: 2772-6096; 2772-6096
• DOI: 10.1016/j.bjao.2025.100398

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, P<0.001) and short form method (ρ=0.66, P<0.001). Peak 3D-CAM-S raw scores also correlated with delirium duration and severity duration area under the curve measures (ρ=0.71, P<0.001 and ρ=0.91, P<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, P<0.001, n=177), slow-wave electroencephalogram power (ρ=0.3, P=0.001, n=73), and plasma neurofilament light (ρ=0.26, P<0.05, n=61) and tau (ρ=0.41, P<0.001, n=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.