Detecting delirium in elderly medical emergency patients: validation and subsequent modification of the German Nursing Delirium Screening Scale

Abstract

Detecting delirium in elderly emergency patients is critical to their outcome. The Nursing Delirium Screening Scale (Nu-DESC) is a short, feasible instrument that allows nurses to systematically screen for delirium. This is the first study to validate the Nu-DESC in a German emergency department (ED). The Nu-DESC was implemented in a high-volume, interdisciplinary German ED. A consecutively recruited sample of medical patients aged ≥ 70 years was screened by assigned nurses who performed the Nu-DESC as part of their daily work routine. The results were compared to a criterion standard diagnosis of delirium. According to the criterion standard diagnosis, delirium was present in 47 (14.9%) out of the 315 patients enrolled. The Nu-DESC shows a good specificity level of 91.0% (95% CI 87.0-94.2), but a moderate sensitivity level of 66.0% (95% CI 50.7-79.1). Positive and negative likelihood ratios are 7.37 (95% CI 4.77-11.36) and 0.37 (95% CI 0.25-0.56), respectively. In an exploratory analysis, we find that operationalizing the Nu-DESC item "disorientation" by specifically asking patients to state the day of the week and the name of the hospital unit would raise Nu-DESC sensitivity to 77.8%, with a specificity of 84.6% (positive and negative likelihood ratio of 5.05 and 0.26, respectively). The Nu-DESC shows good specificity but moderate sensitivity when performed by nurses during their daily work in a German ED. We have developed a modified Nu-DESC version, resulting in markedly enhanced sensitivity while maintaining a satisfactory level of specificity.

Diagnostic test accuracy of the Nursing Delirium Screening Scale: A systematic review and meta‐analysis

“…Another exclusion was due to insufficient data to derive a 2 × 2 table for evaluating Nu‐DESC test accuracy (Poikajarvi et al, 2017) and the other one used a modified, not an original, version of the Nu‐DESC (Kim, Kim, Kim, Yoo, & Park, 2012). Finally, we identified 11 articles that met our eligibility criteria, which were systematically reviewed and used in our meta‐analysis for DTA of the Nu‐DESC (Brich et al., 2018; Gaudreau et al., 2005; Hargrave et al., 2017; Heinrich et al., 2019; Leung et al., 2008; Lingehall et al., 2012; Luetz et al., 2010; Neufeld et al., 2013; Radtke et al., 2008, 2010; Saller et al., 2019). None of the 11 articles was from unpublished literature.…”

Nursing Delirium Screening Scale, a Tool for Early Detection of Delirium: Integrative Review

“…It showed that the evaluation of item 1 (disorientation) combined with two elements of the Mini-Mental State Examination (MMSE) indicates that asking the patient the day of the week and name of the unit where he or she is located increases sensitivity from 66 % to 77.8 %. This finding contrasts with the results obtained in the same study, where the disorientation item was not identified in 14 of 16 false positives cases (32). Although questions arise about the ability of Nu-DESC to detect all forms of delirium, it is necessary to add the capacity to discriminate between delirium and differential diagnosis; Spendale et al demonstrated it in a study of 101 patients hospitalized in different units where 79 % of positive cases had a history of cognitive impairment (33).…”

A complex intervention to promote prevention of delirium in older adults by targeting caregiver’s participation during and after hospital discharge – study protocol of the TRAnsport and DElirium in older people (TRADE) project

“…For the caregivers the Family Confusion Assessment Method (FAM-CAM) will be used [ 31 ]. The five-item Nursing delirium screening scale (Nu-DESC) allows to rate attending nurses’ observations concerning disorientation, inappropriate behavior and communication, hallucinations and psychomotor retardation over a 24-h period [ 32 ]. For the interventional part of the study two easy to use screening instruments for delirium were added to the assessment battery: The bedside confusion scale (BCS) as a simple and short test for delirium that can be derived from 3D-CAM assessment and focuses on the items psychomotor disturbance and awareness [ 33 ].…”