Detection of postoperative delirium by family and caregivers: Evaluation of the family confusion assessment method (FAM-CAM)

Mickle, AM; Tellor Pennington, BR; Abdallah, AB; Wang, W; Lin, N; Oberhaus, J; Budelier, TP; Park, D; Palanca, BJ; Wildes, TS; Schmitt, EM; Inouye, SK; Avidan, MS

doi:10.1016/j.jclinane.2025.111963

Detection of postoperative delirium by family and caregivers: Evaluation of the family confusion assessment method (FAM-CAM)

J Clin AnesthPublished 13 Aug 2025Prespecified sub-study of two multicentre randomised controlled trials

Primary result · Agreement between researcher-rated CAM/CAM-ICU and family-rated FAM-CAM delirium assessmentResultKappa 0.33

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Authors' conclusion

This study demonstrated that family member completed FAM-CAM had acceptable agreement with researchers' delirium assessments. Postoperative delirium symptoms were detected more frequently by family-administered FAM-CAM compared to delirium incidence identified by researcher assessments. Family members identified that some patients experienced delirium symptoms after hospital discharge.

Study context

Population: Older adults undergoing major elective surgery1,349 concurrent assessments
Participants: 817 adults

Comparison: Family-rated FAM-CAM vs researcher-rated Confusion Assessment Method (CAM)/Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)
Primary endpoint: Agreement between researchers' and family members' postoperative delirium assessment
Follow-up: Postoperative days 1-3

Methodological detailsagreement study, pre-specified sub-study

Agreement study
Pre-specified sub-study

Primary result

As reported in the abstract

Agreement between researcher-rated CAM/CAM-ICU and family-rated FAM-CAM delirium assessment

Kappa

0.33

By group

CAM/CAM-ICU

0.938

intraclass correlation

FAM-CAM

0.985

intraclass correlation

Postoperative delirium incidence by researchers' assessment: 18.8 %
Detection of delirium symptoms by FAM-CAM: 22.4 %
Repeated measures Cohen's kappa, good overall agreement: 0.72 (95% CI 0.63 to 0.81)

Secondary outcomes

Positive FAM-CAM after hospital discharge · up to 30 days postoperatively: 18 · events
Positive FAM-CAM after hospital discharge — Booklets returned: 133 (40.3 %) of 330
Positive FAM-CAM after hospital discharge — Also diagnosed with postoperative delirium in hospital: 9 (50 %)

Reference

Authors: Mickle AM, Tellor Pennington BR, Abdallah AB, Wang W, Lin N, Oberhaus J, et al.
All 13 authors
Mickle AM, Tellor Pennington BR, Abdallah AB, Wang W, Lin N, Oberhaus J, Budelier TP, Park D, Palanca BJ, Wildes TS, Schmitt EM, Inouye SK, Avidan MS
Journal: Journal of Clinical Anesthesia
Published: 13 Aug 2025
DOI: 10.1016/j.jclinane.2025.111963
PubMed: 40812167

Topic: Perioperative medicine & outcomes

Intervention details

FAM-CAM: Family Confusion Assessment Method completed by family members, postoperative days 1-3
CAM/CAM-ICU: researcher-rated CAM long-form or CAM-ICU, plus structured chart review

Key notes

Assessment by features showed similar results
Observed agreement beyond chance 79.7 %; Generalized Linear Mixed Modeling with repeated measures; FAM-CAM more likely to report a positive delirium outcome

More notes

1349 concurrent delirium assessments

Original publication

Detection of postoperative delirium by family and caregivers: Evaluation of the family confusion assessment method (FAM-CAM). J Clin Anesth. Published 13 August 2025. doi:10.1016/j.jclinane.2025.111963

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