Appendix Table 2. Association of CAM-S with Post-Hospital Outcomes Stratified by Delirium Diagnosis*.
| Post-Hospital Outcome | Death at 90 Days | Cost Per Day, First 90 Days |
Nursing Home Residence or Death at 90 Days |
Functional Decline at 30 Days | |||
|---|---|---|---|---|---|---|---|
| n/N (%) | Adj. Mean Probability (95% CI) |
Adj. Mean (95% CI), $ |
n/N (%) | Adj. Mean Probability (95% CI) |
n/N (%) | Adj. Mean Probability (95% CI) |
|
| CAM-S Short Form Severity Rating | |||||||
| Non-Delirious Group | N=804 | N=732 | N=735 | N=650 | |||
| Scores of 0 (n=598) | 39/598 (7) | 6.9 (5.0, 8.8) | 109.8 (95.6, 124.1) | 81/544 (15) | 15.3 (12.4, 18.2) | 143/497 (29) | 29.1 (25.3, 32.9) |
| Scores of 1 (n=91) | 14/91 (15) | 11.4 (8.9, 14.0) | 151.0 (126.6, 175.4) | 27/82 (33) | 27.4 (23.2, 31.6) | 29/70 (41) | 38.1 (33.2, 43.0) |
| Scores of 2-3 (n=115) | 18/115 (16) | 17.0 (11.0, 23.0) | 204.2 (147.3, 261.0) | 41/109 (38) | 39.6 (31.5, 47.7) | 36/83 (43) | 44.1 (34.6, 53.6) |
| Ptrend | --- | <.001 | <.001 | --- | <.001 | --- | <.01 |
| Delirious Group | N=115 | N=99 | N=109 | N=62 | |||
| Scores of 2 (n=15)† | 2/15 (13) | 14.5 (3.6, 25.3) | 174.2 (112.4, 235.9) | 8/14 (57) | 41.1 (27.0, 55.1) | 5/10 (50) | 46.6 (25.2, 67.9) |
| Scores of 3-4 (n=64) | 15/64 (23) | 21.9 (14.1, 29.8) | 182.3 (148.0, 216.6) | 27/61 (44) | 49.8 (41.0, 58.6) | 17/35 (49) | 49.8 (36.7, 62.8) |
| Scores of 5-7 (n=36) | 13/36 (36) | 38.3 (24.3, 52.3) | 226.8 (160.6, 292.9) | 21/34 (62) | 58.5 (44.6, 72.3) | 11/17 (65) | 64.3 (44.9, 83.7) |
| Ptrend | --- | 0.02 | 0.21 | --- | 0.32 | --- | 0.32 |
| CAM-S Long Form Severity Rating | |||||||
| Non-Delirious Group | N=804 | N=732 | N=735 | N=650 | |||
| Scores of 0-1 (n=205) | 14/205 (7) | 5.5 (3.5, 7.4) | 91.5 (76.1, 107.0) | 24/181 (13) | 11.2 (8.2, 14.2) | 35/175 (20) | 22.8 (18.2, 27.3) |
| Scores of 2 (n=288) | 20/288 (7) | 8.3 (6.3, 10.4) | 115.1 (100.6, 129.7) | 37/263 (14) | 16.2 (13.3, 19.1) | 67/238 (28) | 27.7 (24.0, 31.4) |
| Scores of 3-10 (n=311) | 37/311 (12) | 11.5 (8.5, 14.5) | 164.7 (133.6, 195.7) | 88/291 (30) | 29.6 (25.1, 34.1) | 106/237 (45) | 43.1 (37.7, 48.6) |
| Ptrend | --- | <.01 | <.001 | --- | <.001 | --- | <.001 |
| Delirious Group | N=115 | N=99 | N=109 | N=62 | |||
| Scores of 4-6 (n=41) | 8/41 (20) | 16.2 (7.4, 24.9) | 161.7 (118.8, 204.6) | 16/38 ( 42) | 37.9 (26.6, 49.1) | 12/26 (46) | 46.9 (30.1, 63.6) |
| Scores of 7-10 (n=42) | 8/42 (19) | 23.8 (16.1, 31.5) | 208.7 (166.3, 251.1) | 20/40 ( 50) | 56.3 (48.2, 64.5) | 12/21 (57) | 53.1 (40.4, 65.8) |
| Scores of 11-19 (n=32) | 14/32 (44) | 41.8 (27.5, 56.1) | 216.1 (151.3, 281.0) | 20/31 ( 65) | 61.5 (47.7, 75.4) | 9/15 (60) | 64.4 (44.8, 84.1) |
| Ptrend | --- | <.01 | 0.18 | --- | 0.06 | --- | 0.22 |
Analyses conducted in Project Recovery. The maximal CAM-S score during each patient’s hospitalization was used in all analyses. Adjusted mean probabilities are predictive margins obtained from logistic regression. Adjusted mean costs and length of stay are predictive margins obtained from log-gamma regression.
This delirious group (with CAM-S scores of 2) was based on clinical adjudication and chart review. Sensitivity analyses excluding this group reveal similar results.
In those who were available for telephone follow up interviews at one-month (N=650), functional decline defined as decline by 2 or more points on the 14-point Activities of Daily Living (ADL) score (equivalent to 1 ADL on the standard 7-point scale) between baseline and 30 days. Adj=adjusted; CI=confidence interval. Deaths within 90 days include all in-hospital deaths. All models are adjusted for age, sex, nonwhite race, Apache II score, Charlson comorbidity index, and baseline dementia. All models except the model for functional decline were also adjusted for baseline impairment in activities of daily living. Medicare data (nursing home and costs) were missing for 75 patients (including those receiving care in health maintenance organizations). The cost per day analyses additionally excluded 13 patients who died during hospitalization.