Fast, Systematic, and Continuous Delirium Assessment in Hospitalized Patients: The Nursing Delirium Screening Scale

Gaudreau, Jean–David; Gagnon, Pierre; Harel, François; Tremblay, Annie; Roy, Marc‐André

doi:10.1016/j.jpainsymman.2004.07.009

Cited by 534 publications

(449 citation statements)

References 34 publications

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“…The Nu-DESC was determined to be congruent to the overall concept of delirium based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders and was of comparable sensitivity and diagnostic accuracy. 5 To our knowledge, no other delirium instrument presents such advantageous characteristics. Follow-up began after incident delirium (the first Nu-DESC score !2) and ended with the patient's discharge from the hospital.…”

Section: Outcome Measurementioning

confidence: 99%

“…Sensitivity, specificity, and efficiency of 85.7%, 86.8%, and 86.4%, respectively, were achieved based on the Nu-DESC validation study. 5 The performance of the Nu-DESC was tested previously by using the Confusion Assessment Method (CAM) 12 as the reference standard. The CAM was administered by study nurses who were blinded to the patients' Nu-DESC delirium status, and the results were confirmed by experienced clinical psychiatrists who also were blinded to the patients' delirium status.…”

Section: Outcome Measurementioning

confidence: 99%

“…In delirium research, an effective way to monitor delirium status over time is using a continuously rated instrument, such as the Nursing Delirium Screening Scale (Nu-DESC). 5 Patients do not necessarily face the same risk of delirium after a first occurrence, and those patients should not be included in the analyses as new patients. Two approaches can be used to take this into account.…”

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confidence: 99%

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Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

Gaudreau

Gagnon

Roy

et al. 2007

Cancer

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BACKGROUND.Delirium is an important problem in hospitalized cancer patients. The objective of this study was to determine whether exposure to corticosteroids, benzodiazepines, or opioids predicted delirium.METHODS.A prospective cohort study was conducted in an oncology/internal medicine population. Patients were assessed continuously for the presence of delirium until they were discharged by using the Nursing Delirium Screening Scale (Nu‐DESC). Follow‐up for outcome began after incident delirium. The primary outcome was the presence of a delirium event, which was defined as a Nu‐DESC score >1. Strengths of associations of medications with delirium were expressed as odds ratios (ORs) in univariate and multivariate analyses.RESULTS.In total, 114 patients (1823 patient‐days) met the inclusion criteria for the study. The mean follow‐up from incident delirium was 16 days. The mean number of delirium events by patient was 6 (total number, 667 delirium events). Analysis by day on several occasions revealed significant associations between opioids and delirium. Corticosteroids and benzodiazepines were not associated significantly with an increased risk of delirium on any given day. Analysis by patient using generalized estimating equation (GEE) models showed an increased risk of delirium on any day of follow‐up associated with opioid exposure in univariate analysis (OR of 1.70; P < .0001). The association remained significant after adjustment for corticosteroid, benzodiazepine, and antipsychotic exposure using GEE regressions (OR of 1.37; P = .0033). Truncating follow‐up at 30 days did not affect the results (OR of 1.38; P < .032).CONCLUSIONS.Exposure to opioids during hospitalization was associated significantly with an increased longitudinal risk of delirium. Cancer 2007. © 2007 American Cancer Society.

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Section: Outcome Measurementioning

confidence: 99%

Section: Outcome Measurementioning

confidence: 99%

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confidence: 99%

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Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

Gaudreau

Gagnon

Roy

et al. 2007

Cancer

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“…Methods: The Korean Nu-DESC was developed based on the Nu-DESC (Gaudreau, 2005), and revised according to nursing records related to signs and symptoms of older patients with delirium (n= 361) and the results of a pilot study (n= 42) in one general hospital. To test the validity of the Korean Nu-DESC, 75 older patients whom nurses suspected of delirium from 731 older patients from 12 nursing units were assessed by bedside nurses using the Korean Nu-DESC.…”

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confidence: 99%

Development and validation of the Korean Nursing Delirium Scale

Kim

et al. 2012

J Korean Acad Nurs

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Purpose: The aims of this study were to develop and test the validity of the Korean Nursing Delirium Scale (Nu-DESC) for older patients in hospital. Methods: The Korean Nu-DESC was developed based on the Nu-DESC (Gaudreau, 2005), and revised according to nursing records related to signs and symptoms of older patients with delirium (n= 361) and the results of a pilot study (n= 42) in one general hospital. To test the validity of the Korean Nu-DESC, 75 older patients whom nurses suspected of delirium from 731 older patients from 12 nursing units were assessed by bedside nurses using the Korean Nu-DESC. A Receiver Operating Characteristic Curve of the Korean Nu-DESC was constructed with an accompanying Area Under the Curve (AUC). Results: Specific examples such as irritable, kidding, sleeping tendency, which were observed by bedside nurses in Korea, were identified in the five features of signs and symptoms of delirium in the instrument. The Korean Nu-DESC was psycho-metrically valid and had a sensitivity and specificity of .81-.76 and .97-.73, respectively. The AUC were .89, .74. Conclusion: Results of this study indicate that the Korean Nu-DESC is well-suited for widespread clinical use in busy inpatients settings and shows promise as a research instrument.

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“…Most units had no routine screening processes despite its prevalence in cancer care [16]. The tools that will be used in the studies (which could be reasonably used in clinical practice) will be the Memorial Delirium Assessment Scale [2] and the Nursing Delirium Screening scale [9]. No unit was routinely using a screening scale or diagnostic tool even when a new episode of delirium was clinically suspected.…”

Section: Limitations -Methodsmentioning

confidence: 99%

Planning phase III multi-site clinical trials in palliative care: the role of consecutive cohort audits to identify potential participant populations

Currow

Shelby‐James

Agar

et al. 2009

Support Care Cancer

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Goals of Work:Multiple sites enable more successful completion of adequately powered phase III studies in palliative care. Audits of the frequency and distribution of the symptoms of interest can better inform research planning by determining realistic recruitment goals for each site. The proposed studies are to improve the evidence-base for registration and subsidy applications for frequently encountered symptoms where current pharmacological interventions are being used 'off-licence'.Methods: Six services participated in a standardized, retrospective, consecutive cohort audit of five symptoms of their inpatient populations to inform the design of double blind randomised controlled phase III studies to which each site would recruit simultaneously. The audit covered all deaths in a three month period for people who were referred to a specialist palliative care service who had at least one inpatient admission between referral and death regardless of when the person was referred to the service. The audits were based around inclusion and exclusion criteria for the proposed studies.Main Results: Of the 468 people whose medical records were reviewed, potential study participant rates varied by symptom having accounted for general and specific inclusion and exclusion criteria: pain 17.7%; delirium 5.8%; anorexia 5.1%; bowel obstruction 2.8% and cholestatic itch 0%. For those people with a symptom of interest, it was noted at the beginning of the inpatient admission more than half the time. Of all inpatients, fewer then one third would be eligible to participate in at least one study. Conclusions:These data provide a baseline estimate of potential people to approach about clinical trials in supportive care but do not account for clinician 'gate-keeping', lack of interest in participating nor withdrawal from the study once initiated. The data are retrospective and therefore limited by clinical documentation. The audit directly informed an increase in the number of participating sites. Page 2 of 11Archived at Flinders University: dspace.flinders.edu.au INTRODUCTIONLarge scale trials in supportive, palliative and hospice care are feasible, especially if protocols can be designed appropriately for use in several sites simultaneously [6]. One reason for the failure of many studies in palliative care is an over-estimation of likely recruitment even for frequently encountered symptoms. A more comprehensive understanding of patterns of symptom occurrence for each participating site (given local variations in referral patterns) and general factors that may affect potential phase III study participation in a supportive and palliative care population need to be included in feasibility assessment. The design needs to take careful account of such findings if studies are going to be successful, and key performance indicators for each site can be tailored to local symptom patterns to monitor trial progress.

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Fast, Systematic, and Continuous Delirium Assessment in Hospitalized Patients: The Nursing Delirium Screening Scale

Cited by 534 publications

References 34 publications

Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

Development and validation of the Korean Nursing Delirium Scale

Planning phase III multi-site clinical trials in palliative care: the role of consecutive cohort audits to identify potential participant populations

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