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Engström, Karl Gunnar
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Publications (10 of 47) Show all publications
Ljungberg, J., Johansson, B., Engström, K. G., Norberg, M., Bergdahl, I. A. & Söderberg, S. (2019). Arterial hypertension and diastolic blood pressure associate with aortic stenosis. Scandinavian Cardiovascular Journal, 53(2), 91-97
Open this publication in new window or tab >>Arterial hypertension and diastolic blood pressure associate with aortic stenosis
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2019 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 53, no 2, p. 91-97Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Due to age-related differences in aortic valve structure, it is likely that the pathophysiology of aortic stenosis (AS) and associated risk factors differ between age groups. Here we prospectively studied the influence of traditional cardiovascular risk factors on AS development requiring surgery among patients without concomitant coronary artery disease (CAD) and stratified for age.

DESIGN: This study included 322 patients, who had prior to surgery for AS participated in population-based surveys, and 131 of them had no visible CAD upon preoperative coronary angiogram. For each case, we selected four referents matched for age, gender, and geographic area. To identify predictors for surgery, we used multivariable conditional logistic regression with a model including arterial hypertension (or measured blood pressure and antihypertensive medication), cholesterol levels, diabetes, body mass index (BMI), and smoking.

RESULTS: In patients without CAD, future surgery for AS was associated with arterial hypertension and elevated levels of diastolic blood pressure in patients younger than 60 years at surgery (odds ratio [95% confidence interval]), (3.40 [1.45-7.93] and 1.60 [1.09-2.37], respectively), and with only impaired fasting glucose tolerance in patients 60 years or older at surgery (3.22 [1.19-8.76]).

CONCLUSION: Arterial hypertension and elevated diastolic blood pressure are associated with a risk for AS requiring surgery in subjects below 60 years of age. Strict blood pressure control in this group is strongly advocated to avoid other cardiovascular diseases correlated to hypertension. If hypertension and elevated diastolic blood pressure are risk factors for developing AS requiring surgery need further investigations. Notably, elevated fasting glucose levels were related to AS requiring surgery in older adults without concomitant CAD.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Aortic stenosis, bicuspid aortic valve, diabetes, hypertension, valve disease surgery
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-159471 (URN)10.1080/14017431.2019.1605094 (DOI)000469026200007 ()31109205 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20140799Swedish Heart Lung Foundation, 20120631Swedish Heart Lung Foundation, 20100635Västerbotten County Council, VLL-548791
Available from: 2019-05-28 Created: 2019-05-28 Last updated: 2019-06-17Bibliographically approved
Sandström, A., Sandberg, C., Rinnström, D., Engström, K. G., Dellborg, M., Thilen, U., . . . Johansson, B. (2019). Factors associated with health-related quality of life among adults with tetralogy of Fallot. Open heart, 6(1), Article ID e000932.
Open this publication in new window or tab >>Factors associated with health-related quality of life among adults with tetralogy of Fallot
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2019 (English)In: Open heart, E-ISSN 2053-3624, Vol. 6, no 1, article id e000932Article in journal (Refereed) Published
Abstract [en]

Background: Due to improved care, the numbers of patients with tetralogy of Fallot (ToF) are increasing. However, long-term morbidity and need for reinterventions are concerns and also address issues of quality of life (QoL).

Methods: Patients with ToF and valid EuroQol-5 dimensions questionnaire (EQ-5D) were identified in the national Swedish register on congenital heart disease. EQ-5Dindex was calculated and dichotomised into best possible health-related QoL (EQ-5Dindex=1) or differed from 1.

Results: 288 patients met the criteria and were analysed. Univariate logistic regression showed a positive association between New York Heart Association (NYHA) class I (OR 8.32, 95% CI 3.80 to 18.21), physical activity >3 h/week (OR 3.34, 95% CI 1.67 to 6.66) and a better right ventricular function (OR 2.56, 95% CI 1.09 to 6.02). A negative association between symptoms (OR 0.23, 95% CI 0.13 to 0.42), cardiovascular medication (OR 0.31, 95% CI 0.18 to 0.53), age (OR 0.97, 95% CI 0.96 to 0.99) and EQ-5Dindex was observed. In multivariate logistic regression, NYHA I (OR 7.28, 95% CI 3.29 to 16.12) and physical activity >3 h/week (OR 2.27, 95% CI 1.07 to 4.84) remained associated with best possible health-related QoL. Replacing NYHA with symptoms in the model yielded similar results.

Conclusion: In this registry study, self-reported physical activity, staff-reported NYHA class and absence of symptoms were strongly associated with best possible health-related QoL measured by EQ-5D. Physical activity level is a potential target for intervention to improve QoL in this population but randomised trials are needed to test such a hypothesis.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-161553 (URN)10.1136/openhrt-2018-000932 (DOI)000471922200023 ()30997127 (PubMedID)
Funder
Västerbotten County CouncilSwedish Heart Lung Foundation
Available from: 2019-07-10 Created: 2019-07-10 Last updated: 2019-07-10Bibliographically approved
Smulter, N., Claesson Lingehall, H., Gustafson, Y., Olofsson, B. & Engström, K. G. (2019). The use of a screening scale improves the recognition of delirium in older patients after cardiac surgery: a retrospective observational study. Journal of Clinical Nursing, 28(11-12), 2309-2318
Open this publication in new window or tab >>The use of a screening scale improves the recognition of delirium in older patients after cardiac surgery: a retrospective observational study
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2019 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 11-12, p. 2309-2318Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: This study analyzed postoperative delirium (POD) in clinical practice after cardiac surgery, how it is detected and documented and if the use of a screening scale improves the detection rate.

BACKGROUND: Cardiac surgery is considered a routine procedure with few complications. However, POD remains a concern, although often being overlooked in clinical practice.

DESIGN: Retrospective observational analysis.

METHODS: Patients 70 years and older with POD (n=78) undergoing cardiac surgery were included in the study. Discharge summaries of both nurses and physicians were reviewed together with the clinical database for information about POD, to be compared with symptom screening using the Nursing Delirium Screening Scale (Nu-DESC). A quantitative content analysis was used for the review of discharge summaries, with a coding scheme adopted from the Nu-DESC method. The STROBE checklist was followed.

RESULTS: In discharge summaries 41 of the 78 POD patients were correctly recognized, and 22 of these were identified in the clinical database. Screening by the Nu-DESC identified delirium at a measurably higher rate, 56/78 patients. The review of discharge summaries showed that patients expressing 'inappropriate behaviour' was the most easily identified sign for POD for both nurses and physicians.

CONCLUSIONS: Healthcare professionals underdiagnose delirium after cardiac surgery, with a low detection rate described in both discharge summaries and in the clinical database. Recognition of delirium improved when Nu-DESC was used for systematic screening.

RELEVANCE TO CLINICAL PRACTICE: This study emphasizes the need for better screening for the detection of delirium in daily clinical practice. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Assessments scales, Cardiac surgery, Clinical database, Documentation, Postoperative delirium
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-157010 (URN)10.1111/jocn.14838 (DOI)000467448000026 ()30791158 (PubMedID)2-s2.0-85062685218 (Scopus ID)
Note

Originally included in thesis in manuscript form

Available from: 2019-03-05 Created: 2019-03-05 Last updated: 2019-08-06Bibliographically approved
Smulter, N., Lingehall, H. C., Gustafson, Y., Olofsson, B., Engström, K. G., Appelblad, M. & Svenmarker, S. (2018). Disturbances in Oxygen Balance During Cardiopulmonary Bypass: A Risk Factor for Postoperative Delirium. Journal of Cardiothoracic and Vascular Anesthesia, 32(2), 684-690
Open this publication in new window or tab >>Disturbances in Oxygen Balance During Cardiopulmonary Bypass: A Risk Factor for Postoperative Delirium
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2018 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 32, no 2, p. 684-690Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to determine risk factors for postoperative delirium after cardiac surgery, specifically associated with the conduct of cardiopulmonary bypass (CPB).

Design: Prospective observational study.

Setting: Heart Centre, University Hospital.

Participants: The study included 142 patients aged 70 years and older scheduled for elective cardiac surgery with CPB.

Interventions: Risk factor analysis comprised information collected from the hospital clinical and CPB dedicated databases in addition to the medical chart. Delirium was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criterion using the Mini Mental State Examination and the Organic Brain Syndrome scale.

Measurements and Main Results: Assessments of delirium diagnosis were executed preoperatively and on the following first and fourth postoperative days. Delirium occurred in 55% (78/142) of the patients. Patients with delirium were identified with significantly higher body weight and body surface area preoperatively, accompanied with longer CPB time, higher positive fluid balance per CPB, and lower systemic pump flow related to body surface area. Furthermore, the duration of the mixed venous oxygen saturation (SvO2) below 75% was significantly longer during CPB. The result from the multivariable logistic regression analysis included the duration of SvO2 below 75%, fluid balance per CPB and patient age as independent risk factors for postoperative delirium.

Conclusions: The influence of the SvO2 level during CPB, fluid balance, and patient age should be recognized as risk factors for postoperative delirium after cardiac surgery in patients 70 years and older.

Place, publisher, year, edition, pages
Saunders Elsevier, 2018
Keywords
cardiac surgery, cardiopulmonary bypass, mixed venous oxygen saturation, postoperative delirium, risk factors
National Category
Nursing Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-144659 (URN)10.1053/j.jvca.2017.08.035 (DOI)000429083200014 ()29153931 (PubMedID)
Available from: 2018-02-09 Created: 2018-02-09 Last updated: 2019-05-22Bibliographically approved
Engström, K. G., Angrén, J., Björnstig, U. & Saveman, B.-I. (2018). Mass casualty incidents in the underground mining industry: applying the Haddon Matrix on an integrative literature review. Disaster Medicine and Public Health Preparedness, 12(1), 138-146
Open this publication in new window or tab >>Mass casualty incidents in the underground mining industry: applying the Haddon Matrix on an integrative literature review
2018 (English)In: Disaster Medicine and Public Health Preparedness, ISSN 1935-7893, E-ISSN 1938-744X, Vol. 12, no 1, p. 138-146Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Underground mining is associated with obvious risks that can lead to mass casualty incidents. Information about such incidents was analyzed in an integrated literature review.

METHODS: A literature search (1980-2015) identified 564 modern-era underground mining reports from countries sharing similar occupational health legislation. These reports were condensed to 31 reports after consideration of quality grading and appropriateness to the aim. The Haddon matrix was used for structure, separating human factors from technical and environmental details, and timing.

RESULTS: Most of the reports were descriptive regarding injury-creating technical and environmental factors. The influence of rock characteristics was an important pre-event environmental factor. The organic nature of coal adds risks not shared in hard-rock mines. A sequence of mechanisms is commonly described, often initiated by a human factor in interaction with technology and step-wise escalation to involve environmental circumstances. Socioeconomic factors introduce heterogeneity. In the Haddon matrix, emergency medical services are mainly a post-event environmental issue, which were not well described in the available literature. The US Quecreek Coal Mine incident of 2002 stands out as a well-planned rescue mission.

CONCLUSION: Evaluation of the preparedness to handle underground mining incidents deserves further scientific attention. Preparedness must include the medical aspects of rescue operations.

Place, publisher, year, edition, pages
Cambridge University Press, 2018
Keywords
mass casualty incident, medical emergency, preparedness, rescue, underground mining
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-137579 (URN)10.1017/dmp.2017.31 (DOI)000428215300023 ()28592339 (PubMedID)
Available from: 2017-07-05 Created: 2017-07-05 Last updated: 2018-06-09Bibliographically approved
Claesson Lingehall, H., Smulter, N., Lindahl, E., Lindkvist, M., Engström, K. G., Gustavsson, Y. & Olofsson, B. (2017). Preoperative Cognitive Performance and Postoperative Delirium Are independently Associated With Future Dementia in Older People Who Have Undergone Cardiac Surgery: A Longitudinal Cohort Study. Critical Care Medicine, 45(8), 1295-1303
Open this publication in new window or tab >>Preoperative Cognitive Performance and Postoperative Delirium Are independently Associated With Future Dementia in Older People Who Have Undergone Cardiac Surgery: A Longitudinal Cohort Study
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2017 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 45, no 8, p. 1295-1303Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate if postoperative delirium was associated with the development of dementia within 5 years after cardiac surgery.

Design: Longitudinal cohort study.

Setting: Cardiothoracic Division, Umeå University Hospital, Sweden.

Patients: Patients aged 70 years old or older (n = 114) scheduled for routine cardiac procedures with cardiopulmonary bypass without documented dementia were enrolled in 2009.

Intervention: Structured assessments were performed preoperatively, 1 and 4 days after extubation, and 1, 3, and 5 years postoperatively.

Measurements and Main Results: Patients were assessed comprehensively, including cognitive and physical function, coexisting medical conditions, demographic characteristics, and medications. Diagnoses of delirium, depression, and dementia were made according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria. During the 5-year period, 30 of 114 participants (26.3%) developed dementia. Postoperative delirium had occurred in 87% of those who later developed dementia. A multivariable logistic regression model showed a lower preoperative Mini-Mental State Examination score (p < 0.001; odds ratio, 0.68; 95% CI, 0.54–0.84) and the occurrence of postoperative delirium (p = 0.002; odds ratio, 7.57; 95% CI, 2.15–26.65) were associated with dementia occurrence.

Conclusions: Our findings suggest that older patients with reduced preoperative cognitive functions or who develop postoperative delirium are at risk of developing dementia within 5 years after cardiac surgery. Cognitive functions should be screened for preoperatively, those who develop postoperative delirium should be followed up to enable early detection of dementia symptoms, and management should be implemented.

Keywords
cardiac surgery, cardiovascular disease, delirium, dementia, older people
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-135501 (URN)10.1097/CCM.0000000000002483 (DOI)000405469600027 ()
Available from: 2017-05-30 Created: 2017-05-30 Last updated: 2018-06-09Bibliographically approved
Karlsson, S., Gyllencreutz, L., Engström, G., Björnstig, U. & Saveman, B.-I. (2017). Preparedness for mining injury incidents: interviews with Swedish rescuers. Safety Science Monitor, 20(1), Article ID 5.
Open this publication in new window or tab >>Preparedness for mining injury incidents: interviews with Swedish rescuers
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2017 (English)In: Safety Science Monitor, ISSN 1443-8844, Vol. 20, no 1, article id 5Article in journal (Refereed) Published
Abstract [en]

Objectives. To explore the perceptions and experiences of mining-, rescue service- (RS), and emergency medical service (EMS) personnel regarding how to handle incidents in an underground mine.

Methods. Six focus-group interviews and 10 individual interviews were carried out with groups of mining-, RS and EMS personnel, who served the underground mining industry located in small municipalities in a sparsely populated area of northern Sweden. The transcripts of the interviews were analysed using qualitative content analysis.

Results. The three groups mostly described experiences of minor incidents and announced a limited preparedness for handling major mining incidents. Collaboration was described as being difficult because of limited knowledge about the others’ responsibilities and capacities. Few non-mining personnel were trained, or prepared to fulfil their tasks in an underground environment, and some expressed that they would even refuse to go underground because of concerns for their own safety.

Conclusions. There is a need for more collaboration and joint practices between and among the groups involved in rescue operations. Collaboration between mine- and RS personnel exists, but the EMS personnel is largely excluded from this interaction. Therefore, the EMS personnel are insecure about how to handle underground mining incidents. A closer collaboration between all organizations in preparing for mining incidents is emphasized, and would have positive effects on the rescue operation. Some experiences may also be used under similar circumstances, such as incidents in railway and road tunnels.

Place, publisher, year, edition, pages
Haninge: IPSO Australia, 2017
Keywords
Collaboration, EMS, mine injury incidents, preparedness, rescue operation, rescue service, Sweden, underground mining
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-138757 (URN)
Available from: 2017-08-30 Created: 2017-08-30 Last updated: 2019-01-15Bibliographically approved
Ljungberg, J., Johansson, B., Engström, K. G., Albertsson, E., Holmer, P., Norberg, M., . . . Söderberg, S. (2017). Traditional Cardiovascular Risk Factors and Their Relation to Future Surgery for Valvular Heart Disease or Ascending Aortic Disease: A Case-Referent Study. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 6(5), Article ID e005133.
Open this publication in new window or tab >>Traditional Cardiovascular Risk Factors and Their Relation to Future Surgery for Valvular Heart Disease or Ascending Aortic Disease: A Case-Referent Study
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2017 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 6, no 5, article id e005133Article in journal (Refereed) Published
Abstract [en]

Background: Risk factors for developing heart valve and ascending aortic disease are based mainly on retrospective data. To elucidate these factors in a prospective manner, we have performed a nested case-referent study using data from large, population-based surveys. Methods and Results: A total of 777 patients operated for heart valve disease or disease of the ascending aorta had previously participated in population-based health surveys in Northern Sweden. Median time (interquartile range) from survey to surgery was 10.5 (9.0) years. Primary indications for surgery were aortic stenosis (41%), aortic regurgitation (12%), mitral regurgitation (23%), and dilatation/dissection of the ascending aorta (17%). For each case, referents were allocated, matched for age, sex, and geographical area. In multivariable models, surgery for aortic stenosis was predicted by hypertension, high cholesterol levels, diabetes mellitus, and active smoking. Surgery for aortic regurgitation was associated with a low cholesterol level, whereas a high cholesterol level predicted surgery for mitral regurgitation. Hypertension, blood pressure, and previous smoking predicted surgery for disease of the ascending aorta whereas diabetes mellitus was associated with reduced risk. After exclusion of cases with coronary atherosclerosis, only the inverse associations between cholesterol and aortic regurgitation and between diabetes mellitus and disease of the ascending aorta remained. Conclusions: This is the first truly prospective study of traditional cardiovascular risk factors and their association with valvular heart disease and disease of the ascending aorta. We confirm the strong association between traditional risk factors and aortic stenosis, but only in patients with concomitant coronary artery disease. In isolated valvular heart disease, the impact of traditional risk factors is varying.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
aortic disease, aortic regurgitation, aortic stenosis, mitral regurgitation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-137815 (URN)10.1161/JAHA.116.005133 (DOI)000404098600027 ()
Available from: 2017-07-26 Created: 2017-07-26 Last updated: 2018-06-09Bibliographically approved
Sandberg, C., Engström, K. G., Dellborg, M., Thilén, U., Wadell, K. & Johansson, B. (2015). The level of physical exercise is associated with self-reported health status (EQ-5D) in adults with congenital heart disease. European Journal of Preventive Cardiology, 22(2), 240-248
Open this publication in new window or tab >>The level of physical exercise is associated with self-reported health status (EQ-5D) in adults with congenital heart disease
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2015 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 2, p. 240-248Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The prognosis in adults with congenital aortic valve disease is usually favourable; nevertheless, a number of medical and social factors might hamper long-term prognosis and quality of life. With a focus on physical exercise level, data from the Swedish National Registry on Congenital Heart Disease (SWEDCON) were analysed and variables associated with health-related quality of life in adults with congenital aortic valve disease were identified.

METHODS: In this registry study, SWEDCON was searched for adult patients with isolated congenital aortic valve disease and valid EuroQol-5Dimensions health questionnaire (EQ-5D) data.

RESULTS: This study identified 315 patients. The majority (n = 202, 64%) reported best possible health status (EQ-5Dindex = 1) whereas 113 (35%) reported some impairment (EQ-5Dindex < 1) with mean EQ-5Dindex 0.73 ± 0.17. In a multivariate logistic regression model, self-reported physical exercise > 3 h/week was independently associated with best possible health status (EQ-5Dindex = 1; p = 0.013). Moreover presence of cardiovascular symptoms (p < 0.001), active smoking (p = 0.002), history of valve surgery (p = 0.017), low educational level (p = 0.022), and higher systolic blood pressure (p = 0.029) were independently associated with impaired health status (EQ-5Dindex < 1).

CONCLUSIONS: Physical exercise >3 h/week was, as a single variable, associated with best possible health status in adults with congenital aortic valve disease. In contrast, a number of medical and social factors are associated with worse self-reported health status. Among these, symptoms, smoking, and educational level are potential targets for modification and intervention. There is a need for studies investigating the effect of increased level of physical exercise in patients with congenital aortic valve disease.

Keywords
Adult congenital heart disease, aortic regurgitation, aortic stenosis, bicuspid aortic valve, EQ-5D
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-82727 (URN)10.1177/2047487313508665 (DOI)000348115400015 ()24108385 (PubMedID)
Available from: 2013-11-07 Created: 2013-11-07 Last updated: 2018-06-08Bibliographically approved
Smulter, N., Claesson Lingehall, H., Gustafson, Y., Olofsson, B. & Engström, K. G. (2015). Validation of the confusion assessment method in detecting postoperative delirium in cardiac surgery patients. American Journal of Critical Care, 24(6), 480-487
Open this publication in new window or tab >>Validation of the confusion assessment method in detecting postoperative delirium in cardiac surgery patients
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2015 (English)In: American Journal of Critical Care, ISSN 1062-3264, E-ISSN 1937-710X, Vol. 24, no 6, p. 480-487Article in journal (Refereed) Published
Abstract [en]

Background: Early detection, prevention, and treatment of delirium after cardiac surgery are important for quick postoperative recovery. The Confusion Assessment Method (CAM) may be an easy-to-use instrument for detecting delirium in clinical practice.

Objectives: To compare the congruent validity of the CAM with the results from repeated assessments by using a combination of the Organic Brain Syndrome Scale and the Mini-Mental State Examination according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria for delirium.

Methods: Patients aged 70 years or older undergoing cardiac surgery were assessed on postoperative days 1 and 4, and the 2 diagnostic methods were compared. The sensitivity and specificity of the CAM were examined. The reference method allowed categorization of delirium into subgroups of psychomotor activities and psychiatric symptom profiles, which were compared with the CAM results.

Results: Postoperative delirium was diagnosed in 78 of 141 patients (55.3%). According to the CAM, 59 patients (41.8%) were categorized as delirious, 53 correctly. Thus, the sensitivity was 68% and the specificity was 90%, indicating false-negative rather than false-positive observations.

Conclusion: Patients with psychomotor hyperactivity and mixed psychotic-emotional symptoms were more likely to have delirium detected via the CAM than were patients with less obvious clinical manifestations of delirium. Repetitive cognitive testing and psychogeriatric experience are probably necessary to improve the results obtained with the CAM.

Place, publisher, year, edition, pages
American Association of Critical-Care Nurses, 2015
Keywords
mini-mental state, risk factors, hospital patients, elderly patients, older people, 3 scores, intervention, fracture, profile, screen
National Category
Nursing Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-111993 (URN)10.4037/ajcc2015551 (DOI)000364316700004 ()26523005 (PubMedID)
Available from: 2015-12-03 Created: 2015-11-30 Last updated: 2018-09-03Bibliographically approved
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