Assessment of Instruments for Measurement of Delirium Severity

Jones, Richard N.; Çizginer, Sevdenur; Pavlech, Laura; Albuquerque, Asha; Daiello, Lori A.; Dharmarajan, Kumar; Gleason, Lauren J.; Helfand, Benjamin; Massimo, Lauren; Oh, Esther S.; Okereke, Olivia I.; Tabloski, Patricia A.; Rabin, Laura A.; Yue, Jirong; Marcantonio, Edward R.; Fong, Tamara G.; Hshieh, Tammy T.; Metzger, Eran D.; Erickson, Kristen; Schmitt, Eva M.; Inouye, Sharon K.

doi:10.1001/jamainternmed.2018.6975

Cited by 68 publications

(81 citation statements)

References 41 publications

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“…Assessing delirium severity. Delirium severity is a complex concept relating to the scale of several potential parameters, such as the extent of cognitive impairment, the level of arousal, the duration of delirium, the number of delirium criteria present and the level of distress experienced by patients 237 . The three main instruments that are most frequently used are CAM-based instruments 207 , the DRS-R98 (reF.…”

Section: Detailed Phenomenological or Neuropsychological Assessment mentioning

confidence: 99%

“…The MDAS and the DRS-R98 (reF. 237 ) are used for delirium assessment as well as to measure delirium severity. Although delirium severity, as measured by these delirium severity tools, is thought to be associated with worse outcomes, such as mortality or long-term cognitive impairment, this is not known.…”

Section: Detailed Phenomenological or Neuropsychological Assessment mentioning

confidence: 99%

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Delirium

Wilson

Mart

Cunningham

et al. 2020

Nat Rev Dis Primers

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602

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Section: Detailed Phenomenological or Neuropsychological Assessment mentioning

confidence: 99%

Section: Detailed Phenomenological or Neuropsychological Assessment mentioning

confidence: 99%

Delirium

Wilson

Mart

Cunningham

et al. 2020

Nat Rev Dis Primers

585

602

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“…Expert panelists generated 207 items and adapted 96 items from legacy instruments, resulting in a total of 303 items for consideration. We selected 103 items for inclusion in our daily hospital interview, and among these we included the severity items from comparator delirium severity instruments (described previously in Jones et al [41]). The expert panel made the decision to exclude one of the domains identified from our previous expert panel process: the domain capturing Functional/Decline or low performance in activities of daily living.…”

Section: Resultsmentioning

confidence: 99%

“…We summarize the steps that our group has taken towards the measurement of delirium severity to date, which includes the work undergone in the current study. First, we conducted a systematic review of the medical literature on assessment of delirium severity and evaluated the quality of existing tools for measuring this construct [41]. Second, we conducted a psychometric synthesis and harmonization of the three most commonly used delirium severity instruments to calibrate the measurement of delirium severity across these legacy instruments using advanced psychometric methods [32].…”

Section: Discussionmentioning

confidence: 99%

New Delirium Severity Indicators: Generation and Internal Validation in the Better Assessment of Illness (BASIL) Study

Vasunilashorn

Tommet

Fong

et al. 2020

Dement Geriatr Cogn Disord

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Background: Delirium is a common and preventable geriatric syndrome. Moving beyond the binary classification of delirium present/absent, delirium severity represents a potentially important outcome for evaluating preventive and treatment interventions and tracking the course of patients. Although several delirium severity assessment tools currently exist, most have been developed in the absence of advanced measurement methodology and have not been evaluated with rigorous validation studies. Objective: We aimed to report our development of new delirium severity items and the results of item reduction and selection activities guided by psychometric analysis of data derived from a field study. Methods: Building on our literature review of delirium instruments and expert panel process to identify domains of delirium severity, we adapted items from existing delirium severity instruments and generated new items. We then fielded these items among a sample of 352 older hospitalized patients. Results: We used an expert panel process and psychometric data analysis techniques to narrow a set of 303 potential items to 17 items for use in a new delirium severity instrument. The 17-item set demonstrated good internal validity and favorable psychometric charac-S.K. Inouye and R.N. Jones contributed equally to this work. For the BASIL Study Team see Appendix A.

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“…Recently, a score-based version of the CAM-ICU (CAM-ICU-7) was developed, with each feature of delirium being assigned a score based on the severity of the disruption [4]. Recent studies suggest measurement of the spectrum of delirium severity, which is possible with score-based delirium detection, in clinical practice may be an important means to identify the earliest onset of symptoms of delirium, target delirium prevention and management strategies, track the effectiveness of these strategies and monitor outcomes for patients with delirium [14,15]. Patients with less than clinical threshold symptoms of delirium (commonly referred to as subsyndromal delirium) could benefit from early nonpharmacological interventions: up to 40% cases of delirium can be prevented [16] or may not progress to clinical delirium [17].…”

Section: Introductionmentioning

confidence: 99%

The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients

et al. 2020

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Background In clinical practice, a dichotomous approach to delirium identification may no longer be relevant when existing delirium screening tools measure a range of scores. The objective of this study was to compare the Confusion Assessment Method for the Intensive Care Unit 7-item (CAM-ICU-7) and the Intensive Care Delirium Screening Checklist (ICDSC) as measures of the spectrum of delirium severity in critically ill adult patients. Methods In this cross-sectional study, 218 patients underwent 641 paired assessments by bedside nurses (ICDSC, as per usual care) and trained research assistants (CAM-ICU-7). Correlation between the CAM-ICU-7 and ICDSC scores was evaluated. Logistic regression was used to explore associations between CAM-ICU-7 or ICDSC score and length of ICU stay and mechanical ventilation (receipt, ≥96 hours). Results Delirium prevalence evaluated by the CAM-ICU-7 and ICDSC were 46.3% (95% CI:39.7–53.0) and 34.4% (95% CI:28.3–41.0). Prevalence of less than clinical threshold symptoms of delirium evaluated by the CAM-ICU-7 (score: 1–2) and ICDSC (score: 1–3) were 30.3% (95%CI:24.5–36.7) and 50.9% (95%CI:44.3–57.6). The CAM-ICU-7 and ICDSC had significant positive correlation (0.58, p<0.001). Agreement between the tools as measures of delirium was moderate (kappa = 0.51) and as measures of less than clinical threshold symptoms of delirium was fair (kappa = 0.21). Less than clinical threshold symptoms of delirium identified by the ICDSC, not CAM-ICU-7, were associated with prolonged length of ICU stay (≥7 days) in patients <65 years of age [Odds Ratio (OR) 9.2, 95% CI:2.5–34.0] and mechanical ventilation (receipt: OR 2.8, 95% CI:1.3–6.4; ≥96 hours: OR 6.6, 95% CI:1.9–22.9), when compared to patients with no delirium. Conclusions The CAM-ICU-7 and ICDSC are measures of the spectrum of delirium severity that are closely correlated. Less than clinical threshold symptoms of delirium measure by the ICDSC is a better predictor of outcomes, when compared with the CAM-ICU-7.

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Assessment of Instruments for Measurement of Delirium Severity

Cited by 68 publications

References 41 publications

Delirium

Delirium

New Delirium Severity Indicators: Generation and Internal Validation in the Better Assessment of Illness (BASIL) Study

The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients

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