Nurses' Recognition of Hospitalized Older Patients With Delirium and Cognitive Impairment Using the Delirium Observation Screening Scale: A Prospective Comparison Study

Abstract

The aim of the current study was to report fi ndings about delirium detection when ward nurses screened for delirium in patients with cognitive impairment using the Delirium Observation Screening Scale (DOSS) in comparison to the Confusion Assessment Method (CAM). A secondary analysis was performed of research data collected in 2010 at a Swiss tertiary university hospital. During the fi rst 5 days after admission, patients 70 and older with cognitive impairment were screened for delirium using the DOSS. Throughout patients' hospital stay, research assistants also completed the CAM on a daily basis. A total of 138 patients who did not have delirium initially participated in the study. Of these patients, 44 (32%) developed delirium with a median duration of 3 days (Q1 = 1.25; Q3 = 5.00). Ward nurses correctly identifi ed delirium using the DOSS in 56% of cases (sensitivity) and no delirium in 92% of cases (specifi city). Although the DOSS was 100% correct in detecting patients with hyperactive delirium, the identifi cation rate decreased to 60% for patients with mixed delirium subtype and 38% for patients with hypoactive delirium. Delirium screening using observational methods may be insuffi ciently sensitive and should be supplemented with a formal attention test.

The importance of increased awareness for delirium in elderly patients with rib fractures after blunt chest wall trauma: a retrospective cohort study on risk factors and outcomes

“…The DOSS was used to screen for delirium by ward nurses. Recent validation studies have shown inconclusive results, with sensitivity rates varying from 56 to 91% [23, 43]. This difference is likely explained due to difficulty in diagnosing the hypoactive subtype of delirium.…”

Validation of two nurse-based screening tools for delirium in elderly patients in general medical wards

“…In a follow-up study, the DOS was reduced to 13 items. A validated German version of the DOS is available [25,26]. Each of the items is rated either as zero (normal behaviours), one (sometimes or often) or not assessable.…”

“…The Nursing Delirium Screening Scale (Nu-DESC) was translated and validated by Luetz et al [22] and Radtke et al [23,24] in different postoperative hospital settings. The Delirium Observation Screening Scale (DOS) was also translated [25] and validated in German [26].…”

An advanced practice nurse‐led delirium consultation service reduces delirium severity and length of stay in orthopedic patients: A nonrandomized posttest only evaluation study

“…14,18 The DOSS was validated in a different hospital and long-term care settings. [20][21][22][23][24][25][26] The highest DOSS score out of three shifts per day was used to assess delirium severity. Delirium duration was measured as the number of days for which the patient had a DOSS score of 3 and more.…”

“…Internal consistency was high with Cronbach's α = 0.93 to 0.96 and predictive validity using DSM‐IV criteria or diagnosis by a geriatrician was good 14,18 . The DOSS was validated in a different hospital and long‐term care settings 20‐26 . The highest DOSS score out of three shifts per day was used to assess delirium severity.…”