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J Hosp Med. 2015 Oct;10(10):645-50. doi: 10.1002/jhm.2418. Epub 2015 Sep 15.

Preliminary development of an ultrabrief two-item bedside test for delirium.

Author information

1
College of Nursing, College of Medicine, Department of Psychiatry, Penn State University, University Park, Pennsylvania.
2
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts.
3
Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
4
Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
5
Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
6
Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.

Abstract

BACKGROUND:

Delirium is common, morbid, and costly, yet is greatly under-recognized among hospitalized older adults.

OBJECTIVE:

To identify the best single and pair of mental status test items that predict the presence of delirium.

DESIGN, SETTING:

Diagnostic test evaluation study that enrolled medicine inpatients aged 75 years or older at an academic medical center.

METHODS:

Patients underwent a clinical reference standard assessment involving a patient interview, medical record review, and interviews with family members and nurses to determine the presence or absence of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition defined delirium. Participants also underwent the three-dimensional Confusion Assessment Method (3D-CAM), a brief, validated assessment for delirium. Individual items and pairs of items from the 3D-CAM were evaluated to determine sensitivity and specificity relative to the reference standard delirium diagnosis.

RESULTS:

Of the 201 participants (mean age 84 years, 62% female), 42 (21%) had delirium based on the clinical reference standard. The single item with the best test characteristics was "months of the year backwards" with a sensitivity of 83% (95% confidence interval [CI]: 69%-93%) and specificity of 69% (95% CI: 61%-76%). The best 2-item screen was the combination of "months of the year backwards" and "what is the day of the week?" with a sensitivity of 93% (95% CI: 81%-99%) and specificity of 64% (95% CI: 56%-70%).

CONCLUSIONS:

We identified a single item with >80% and pair of items with >90% sensitivity for delirium. If validated prospectively, these items will serve as an initial innovative screening step for delirium identification in hospitalized older adults.

PMID:
26369992
PMCID:
PMC4665114
DOI:
10.1002/jhm.2418
[Indexed for MEDLINE]
Free PMC Article

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