• Jennifer G Chester, Mary Beth Harrington, James L Rudolph, and VA Delirium Working Group.
• Albert Einstein College of Medicine, Bronx, New York, USA.
• J Hosp Med. 2012 May 1;7(5):450-3.

ObjectivesBecause delirium is a common yet frequently unrecognized condition, this study sought to design a brief screening tool for a core feature of mental status and to validate the instrument as a serial assessment for delirium.DesignProspective cohort study.SettingTertiary VA Hospital in New England.ParticipantsA total of 95 veterans admitted to the medical service.MethodsA consensus panel developed a modified version of the Richmond Agitation and Sedation Scale (RASS) to capture alterations in consciousness. Upon admission, and daily thereafter, patients were screened with a modified RASS (mRASS) and independently underwent a comprehensive mental status interview by a geriatric expert, who determined whether the criteria for delirium were met. The sensitivity, specificity, and positive likelihood ratio (LR) of the mRASS for delirium are reported.ResultsAs a single assessment, the mRASS had a sensitivity of 64% and a specificity of 93% for delirium (LR, 9.4). When used to detect change, serial mRASS assessments had a sensitivity of 74% and a specificity of 92% (LR, 8.9) in both prevalent and incident delirium. When prevalent cases were excluded, any change in the mRASS had a sensitivity of 85% and a specificity of 92% for incident delirium (LR, 10.2)ConclusionWhen administered daily, the mRASS has good sensitivity and specificity for incident delirium. Given the brevity of the instrument (<30 seconds), consideration should be given to incorporating the modified RASS as a daily screening measure for consciousness and delirium.Copyright © 2012 Society of Hospital Medicine.

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