• J Hosp Med · Oct 2015

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

    • Donna M Fick, Sharon K Inouye, Jamey Guess, Long H Ngo, Richard N Jones, Jane S Saczynski, and Edward R Marcantonio.
    • College of Nursing, College of Medicine, Department of Psychiatry, Penn State University, University Park, Pennsylvania.
    • J Hosp Med. 2015 Oct 1; 10 (10): 645-50.

    BackgroundDelirium is common, morbid, and costly, yet is greatly under-recognized among hospitalized older adults.ObjectiveTo identify the best single and pair of mental status test items that predict the presence of delirium.Design, SettingDiagnostic test evaluation study that enrolled medicine inpatients aged 75 years or older at an academic medical center.MethodsPatients 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.ResultsOf 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%).ConclusionsWe 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.© 2015 Society of Hospital Medicine.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…