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Psychosomatics. 2017 Nov - Dec;58(6):594-603. doi: 10.1016/j.psym.2017.05.005. Epub 2017 Jul 24.

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

Author information

1
Department of Internal Medicine, University of California San Francisco, San Francisco, CA.
2
Department of Psychiatry, University of California San Francisco, San Francisco, CA.
3
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
4
Department of Neurology, University of California San Francisco, San Francisco, CA.
5
Department of Nursing, University of California San Francisco, San Francisco, CA.
6
Department of Anesthesia, University of California San Francisco, San Francisco, CA.
7
Department of Neurology, University of California San Francisco, San Francisco, CA. Electronic address: vanja.douglas@ucsf.edu.

Abstract

BACKGROUND:

Guidelines recommend daily delirium monitoring of hospitalized patients. Available delirium-screening tools have not been validated for use by nurses among diverse inpatients.

OBJECTIVE:

We sought to validate the Nursing Delirium-Screening Scale (Nu-DESC) under these circumstances.

METHODS:

A blinded cross-sectional and quality-improvement study was conducted from August 2015-February 2016. Nurses׳ Nu-DESC scores were compared to delirium diagnosis according to Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria. A total of 405 consecutive hospitalized patients were included. Nu-DESC-positive (threshold score ≥2) patients were matched with equal numbers of Nu-DESC-negative patients, by sex, age, and nursing unit. Nurses recorded a Nu-DESC score for each patient on every 12-hour shift. A Nu-DESC-blinded evaluator interviewed patients for 2 consecutive days. Delirium diagnosis was determined by physicians using DSM-5 criteria applied to collected research data. Sensitivity and specificity of the Nu-DESC were calculated. In an exploratory analysis, the performance of the Nu-DESC was analyzed with the addition of bedside measures of attention.

RESULTS:

The sensitivity of the Nu-DESC at a threshold of ≥2 was 42% (95% CI: 33-53%). Specificity was 98% (97-98%). At a threshold of ≥1, sensitivity was 67% (52-80%) and specificity 93% (90-95%). Similar results were found with the addition of attention tasks.

CONCLUSION:

The Nu-DESC is a specific delirium detection tool, but it is not sensitive at the usually proposed cut point of ≥2. Using a threshold of ≥1 or adding a test of attention increase sensitivity with a minor decrease in specificity.

KEYWORDS:

Nu-DESC; inpatient delirium screening; nursing delirium screen.

PMID:
28750835
PMCID:
PMC5798858
DOI:
10.1016/j.psym.2017.05.005
[Indexed for MEDLINE]
Free PMC Article

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