Validation of a Nurse-Based Delirium-Screening Tool for Hospitalized Patients

Hargrave, Anita S.; Bastiaens, Jesse; Bourgeois, James A.; Neuhaus, John; Josephson, S. Andrew; Chinn, Julia; Lee, Melissa; Leung, Jacqueline M.; Douglas, Vanja C.

doi:10.1016/j.psym.2017.05.005

Cited by 68 publications

(72 citation statements)

References 32 publications

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“…The expected mortality rate for the delirium score was calculated as 25.09%. These results were consistent with the literature [25,27,[41][42][43][44].…”

Section: Discussionsupporting

confidence: 94%

“…The scale shows a high sensitivity and a high specificity, which are particularly important for a screening/monitoring tool and not particularly different from the properties of the ICDSC. The Nu-DESC has values similar to those in other published studies [25,27,[41][42][43][44]. It is in line with nursing studies evaluating the impact of education efforts focusing on use [17].…”

Section: Discussionsupporting

confidence: 86%

See 1 more Smart Citation

Evaluation of Postoperative Delirium: Validity and Reliability of the Nursing Delirium Screening Scale in the Turkish Language

Çınar

Aslan

2019

Dement Geriatr Cogn Disord Extra

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KeywordsNursing personnel · Delirium of mixed origin · Reliability · Validity Abstract Purpose: Postoperative delirium is the most well-known form of postoperative cognitive impairment in all patient groups, especially in the elderly. Delirium is a syndrome that causes serious consequences, increasing mortality and morbidity rates and extending the length of hospital stay. The aim of this study was to evaluate the validity and reliability of the Turkish version of the Nursing Delirium Screening Scale (Nu-DESC). Method: One hundred twelve patients who were hospitalized for a surgical operation in the orthopedics, neurosurgery, and general surgery clinic of a state hospital for 3 months were evaluated concurrently (and independently for delirium). Patients were observed by clinical nurses 3 times over a 24-h period. The presence of delirium was diagnosed by 2 neurologists according to DSM-IV criteria. Student's t test, the χ 2 test, and the Mann-Whitney U test were used, and construct validity, intrascale factor analysis, interrater reliability, and specificity and sensitivity (ROC) analyses were performed for descriptive analysis. SPSS 25.0 and MedCalc18.6 were used for statistical analysis. Results: Delirium was detected in 28 patients according to the Nu-DESC. The ICC (intraclass correlation) is 0.97 in the 95% confidence interval from 0.96 to 0.98 for agreement between nurses and neurologists for the total Nu-DESC score. Weighted κ rates were between 0.78 and 0.92. In the ROC analysis of the Nu-DESC scale, the optimum cutoff value calculated for the 1,344 observations and 112 patients was determined as > 1 according to the maximum sensitivity and the specific situation. Sensitivity at the cut-off point was 92.27; specificity was determined as 92.72. The Youden index was found to be J = 0.845 (0 < J = 0.845 < 1). Conclusion: We believe that Turkish translation of Nu-DESC is valid and reliable for clinicians, nurses, and researchers and will contribute to delirium studies. 41 Radtke FM, Franck M, Schneider M, Luetz A, Seeling M, Heinz A, et al. Comparison of three scores to screen for delirium in the recovery room. Br J Anaesth. 2008 Sep; 101(3): 338-43. 42 Radtke FM, Franck M, Schust S, Boehme L, Pascher A, Bail HJ, et al. A comparison of three scores to screen for delirium on the surgical ward. World J Surg. 2010 Mar; 34(3): 487-94. 43 Neufeld KJ, Leoutsakos JS, Sieber FE, Joshi D, Wanamaker BL, Rios-Robles J, et al. Evaluation of two delirium screening tools for detecting post-operative delirium in the elderly. Br J Anaesth. 2013 Oct; 111(4): 612-8. 44 Hargrave A, Bastiaens J, Bourgeois JA, Neuhaus J, Josephson SA, Chinn J, et al. Validation of a nurse-based delirium-screening tool for hospitalized patients. Psychosomatics. 2017 Nov -Dec; 58(6): 594-603.

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“…The expected mortality rate for the delirium score was calculated as 25.09%. These results were consistent with the literature [25,27,[41][42][43][44].…”

Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 86%

Evaluation of Postoperative Delirium: Validity and Reliability of the Nursing Delirium Screening Scale in the Turkish Language

Çınar

Aslan

2019

Dement Geriatr Cogn Disord Extra

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“…209 There is also ongoing work with other short tests, such as the nursing delirium screen (NuDesc). 210 The choice of tool in a given context will depend on the time available, the desired performance characteristics, the training available, and so on.…”

Section: Discussion Of the Cost-effectiveness Analysismentioning

confidence: 99%

The 4 ‘A’s test for detecting delirium in acute medical patients: a diagnostic accuracy study

MacLullich

Shenkin

Goodacre

et al. 2019

Health Technol Assess

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Background Delirium is a common and serious neuropsychiatric syndrome, usually triggered by illness or drugs. It remains underdetected. One reason for this is a lack of brief, pragmatic assessment tools. The 4 ‘A’s test (Arousal, Attention, Abbreviated Mental Test – 4, Acute change) (4AT) is a screening tool designed for routine use. This project evaluated its usability, diagnostic accuracy and cost. Methods Phase 1 – the usability of the 4AT in routine practice was measured with two surveys and two qualitative studies of health-care professionals, and a review of current clinical use of the 4AT as well as its presence in guidelines and reports. Phase 2 – the 4AT’s diagnostic accuracy was assessed in newly admitted acute medical patients aged ≥ 70 years. Its performance was compared with that of the Confusion Assessment Method (CAM; a longer screening tool). The performance of individual 4AT test items was related to cognitive status, length of stay, new institutionalisation, mortality at 12 weeks and outcomes. The method used was a prospective, double-blind diagnostic test accuracy study in emergency departments or in acute general medical wards in three UK sites. Each patient underwent a reference standard delirium assessment and was also randomised to receive an assessment with either the 4AT (n = 421) or the CAM (n = 420). A health economics analysis was also conducted. Results Phase 1 found evidence that delirium awareness is increasing, but also that there is a need for education on delirium in general and on the 4AT in particular. Most users reported that the 4AT was useful, and it was in widespread use both in the UK and beyond. No changes to the 4AT were considered necessary. Phase 2 involved 785 individuals who had data for analysis; their mean age was 81.4 (standard deviation 6.4) years, 45% were male, 99% were white and 9% had a known dementia diagnosis. The 4AT (n = 392) had an area under the receiver operating characteristic curve of 0.90. A positive 4AT score (> 3) had a specificity of 95% [95% confidence interval (CI) 92% to 97%] and a sensitivity of 76% (95% CI 61% to 87%) for reference standard delirium. The CAM (n = 382) had a specificity of 100% (95% CI 98% to 100%) and a sensitivity of 40% (95% CI 26% to 57%) in the subset of participants whom it was possible to assess using this. Patients with positive 4AT scores had longer lengths of stay (median 5 days, interquartile range 2.0–14.0 days) than did those with negative 4AT scores (median 2 days, interquartile range 1.0–6.0 days), and they had a higher 12-week mortality rate (16.1% and 9.2%, respectively). The estimated 12-week costs of an initial inpatient stay for patients with delirium were more than double the costs of an inpatient stay for patients without delirium (e.g. in Scotland, £7559, 95% CI £7362 to £7755, vs. £4215, 95% CI £4175 to £4254). The estimated cost of false-positive cases was £4653, of false-negative cases was £8956, and of a missed diagnosis was £2067. Limitations Patients were aged ≥ 70 years and were assessed soon after they were admitted, limiting generalisability. The treatment of patients in accordance with reference standard diagnosis limited the ability to assess comparative cost-effectiveness. Conclusions These findings support the use of the 4AT as a rapid delirium assessment instrument. The 4AT has acceptable diagnostic accuracy for acute older patients aged > 70 years. Future work Further research should address the real-world implementation of delirium assessment. The 4AT should be tested in other populations. Trial registration Current Controlled Trials ISRCTN53388093. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 40. See the NIHR Journals Library website for further project information. The funder specified that any new delirium assessment tool should be compared against the CAM, but had no other role in the study design or conduct of the study.

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“…Although the authors dismiss the idea of using clinical tools, the Nursing Delirium Screening Scale has shown comparable (84%) accuracy. 3 On many levels, this may be better for patient care as a whole as improved nursing ratios could in turn lead to improved patient care and intervention with therapies.…”

Section: Referencesmentioning

confidence: 99%

“…The WHO International Classification of functioning, disability, and health classifies disability as 'difficulties in any area of functioning as they relate to environmental and personal factors'. 3 The WHO Disability Assessment Schedule 2.0 (WHODAS) was introduced to measure disability in the aged and for disease-related states. 4 It has been evaluated in surgical populations and has been found to have construct validity, clinical reliability, and responsiveness.…”

Section: Referencesmentioning

confidence: 99%