Audrey Chun, MD; Rosanne M. Leipzig, MD, PhD
What is the accuracy of bedside instruments for diagnosing delirium in hospitalized adults?
Included studies assessed hospitalized patients (not in the intensive care unit), comprising those with and without delirium; used the same bedside index test for > 80% of patients; and applied an appropriate reference standard (DSM-III, DSM-III-R, or DSM-IV administered by a geriatrician, neurologist, or psychiatrist) to all patients and had results available for all reference tests. Exclusion criteria were studies of alcohol-related delirium or pediatric populations, and index and reference tests administered by the same person. Outcomes were sensitivity, specificity, and likelihood ratios (LRs).
MEDLINE and EMBASE/Excerpta Medica were searched to May 2010 for published, prospective, English-language studies; bibliographies of retrieved articles were also reviewed. 25 studies (n = 3027) describing 11 bedside instruments for diagnosing delirium met the selection criteria.
The results are in the Table. The following instruments had +LRs ≥ 5 and −LRs < 0.2: Confusion Assessment Method (CAM), Delirium Observation Screening Scale (DOSS), Delirium Rating Scale-Revised 98, Global Attentiveness Rating (GAR), and Memorial Delirium Assessment Scale.
Several bedside instruments are accurate for diagnosing delirium in hospitalized patients.
Test characteristics of 11 bedside instruments for diagnosing delirium in hospitalized patients*
*CAC = Clinical Assessment of Confusion, CAM = Confusion Assessment Method, DOSS = Delirium Observation Screening Scale, DRS = Delirium Rating Scale, GAR = Global Attentiveness Rating, MDAS = Memorial Delirium Assessment Scale, MMSE = Mini-Mental State Examination, Nu-DESC = Nursing Delirium Screening Scale; diagnostic terms defined in Glossary.
†Results for > 1 study based on pooled data.
Chun A, Leipzig RM. Review: Several bedside instruments are accurate for diagnosing delirium in hospitalized patients. Ann Intern Med. ;154:JC2–12. doi: 10.7326/0003-4819-154-4-201102150-02012
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Published: Ann Intern Med. 2011;154(4):JC2-12.
Delirium, Hospital Medicine, Neurology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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