Delirium scales: A review of current evidence

Abstract

A large number of scales exist, but not all are properly evaluated in terms of psychometric properties, and there is not unanimity about which scale is the best. However, a small number of scales may be considered already to be robust and useable: the CAM, the DRS, the MDAS and the NEECHAM.

Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: A systematic review

“…4 Although the BCS was previously validated in the palliative care setting, it requires further investigation of its psychometric properties. 43 The CRS requires further validation, and the DOCS is not a validated delirium-screening tool. 43 Two cognition assessment tools, used to either screen for delirium or to assist in delirium assessment, were the Mini-Mental State Examination (MMSE) 47 used by psychiatric and medical investigators 4,35,37,41 or clinical staff 41 and the Blessed Orientation Memory Concentration (BOMC) test used by research nurses.…”

“…43 The CRS requires further validation, and the DOCS is not a validated delirium-screening tool. 43 Two cognition assessment tools, used to either screen for delirium or to assist in delirium assessment, were the Mini-Mental State Examination (MMSE) 47 used by psychiatric and medical investigators 4,35,37,41 or clinical staff 41 and the Blessed Orientation Memory Concentration (BOMC) test used by research nurses. 39,48 Three delirium assessment tools were the Confusion Assessment Method (CAM) 49 used by research nurses 39 or medical investigators and trained clinical staff 41 ; the Memorial Delirium Assessment Scale (MDAS) 38,50 used by medical investigators, 4,41 trained clinical staff, 41 or a research nurse 35 ; and the Delirium Rating Scale-Chinese Version (DRS-CV) 51 used by a research nurse.…”

“…Of the six delirium-specific screening or assessment tools, all varied in their validity, purpose (screening, diagnosis, and severity), intended rater (psychiatrically vs nonpsychiatrically trained), ratings procedures (observation vs interview), number of items, and extent to which they correlate with different versions of DSM criteria for delirium. 43,44 Three delirium or "confusion" screening tools included the Confusion Rating Scale (CRS) used by ward nurses 39,45 ; admission to a palliative care unit found that delirium was the most prevalent psychiatric disorder, occurring in 28% of all participants and representing 52% of all psychiatric diagnoses. 37 Another study, using delirium screening during each 8-h shift, identified that 62% of participants developed delirium at some point during hospice admission.…”

Validation of the Confusion Assessment Method in Detecting Postoperative Delirium in Cardiac Surgery Patients

“…21 As might be intuitively realized, the detection rate can be improved by using assessment scales, 19,20,22 but many of the scales available are both time-consuming and require extensive training. 23,24 These assessment scales must also have adequate monitoring details with respect to sensitivity and specificity, and the findings should also be different for the different delirium subtypes. The Organic Brain Syndrome (OBS) Scale is widely used among research professionals in a variety of patients.…”

Quantifying the Severity of a Delirium Episode Throughout Hospitalization: the Combined Importance of Intensity and Duration

“…8 The ability to determine which episodes of delirium are likely to lead to poor clinical outcomes has remained a major area of challenge. To date, clinicians and investigators have characterized delirium by its intensity at a single timepoint [9][10][11][12][13][14] or its total duration 4 in an effort to quantify Bseverity.^How-ever, previous work has not quantified the severity of an entire episode of delirium (such as across an entire hospitalization), which is critical for advancing our understanding of the influence of delirium on clinical outcomes. Such an exploration would require expansion of the concept of delirium severity beyond a single instantaneous rating or counting days with delirium.…”