Format

Send to

Choose Destination
See comment in PubMed Commons below
J Neurol Neurosurg Psychiatry. 2014 Oct;85(10):1122-31. doi: 10.1136/jnnp-2013-307053. Epub 2014 Feb 25.

Attention! A good bedside test for delirium?

Author information

  • 1Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
  • 2Cork University Hospital, Cork, Ireland.
  • 3Department of Psychiatry, University of Limerick, Limerick, Ireland.
  • 4Department of Geriatric Medicine, Waterford Regional Hospital, Waterford, Ireland.
  • 5HRB Clinical Research Facility at UCC, University College Cork, Cork, Ireland.
  • 6Department of Psychiatry, University of Limerick, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland.

Abstract

BACKGROUND:

Routine delirium screening could improve delirium detection, but it remains unclear as to which screening tool is most suitable. We tested the diagnostic accuracy of the following screening methods (either individually or in combination) in the detection of delirium: MOTYB (months of the year backwards); SSF (Spatial Span Forwards); evidence of subjective or objective 'confusion'.

METHODS:

We performed a cross-sectional study of general hospital adult inpatients in a large tertiary referral hospital. Screening tests were performed by junior medical trainees. Subsequently, two independent formal delirium assessments were performed: first, the Confusion Assessment Method (CAM) followed by the Delirium Rating Scale-Revised 98 (DRS-R98). DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria were used to assign delirium diagnosis. Sensitivity and specificity ratios with 95% CIs were calculated for each screening method.

RESULTS:

265 patients were included. The most precise screening method overall was achieved by simultaneously performing MOTYB and assessing for subjective/objective confusion (sensitivity 93.8%, 95% CI 82.8 to 98.6; specificity 84.7%, 95% CI 79.2 to 89.2). In older patients, MOTYB alone was most accurate, whereas in younger patients, a simultaneous combination of SSF (cut-off 4) with either MOTYB or assessment of subjective/objective confusion was best. In every case, addition of the CAM as a second-line screening step to improve specificity resulted in considerable loss in sensitivity.

CONCLUSIONS:

Our results suggest that simple attention tests may be useful in delirium screening. MOTYB used alone was the most accurate screening test in older people.

KEYWORDS:

ATTENTION; COGNITION; NEUROPSYCHIATRY

PMID:
24569688
PMCID:
PMC4173985
DOI:
10.1136/jnnp-2013-307053
[PubMed - indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Support Center