Use of an expert panel to identify domains and indicators of delirium severity

Schmitt, Eva M.; Fong, Tamara G.; Vasunilashorn, Sarinnapha; Gallagher, J. Roswell; Marcantonio, Edward R.; Brown, Charles H.; Clark, Diane; Flaherty, Joseph H.; Gleason, Anne; Gordon, Sharon M.; Kolanowski, Ann; Neufeld, Karin J.; O’Connor, Margaret; Pisani, Margaret A.; Robinson, Thomas N.; Wald, Heidi L.; Jones, Richard N.; Inouye, Sharon K.

doi:10.1007/s11136-019-02201-0

Cited by 9 publications

(30 citation statements)

References 20 publications

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“…This was a local expert panel, and it was distinct from the external expert panel that participated in the identification and definition of content domains [c.f. 10].…”

Section: Methodsmentioning

confidence: 99%

“…Items were generated in two ways: adapted from existing instruments and generated de novo. To generate new items, the experts adhered to the following steps: aligning the item with the domain definitions provided by our external expert panel [10], and crafting new items specifying the domain, interview instructions (e.g., for interaction with patient, family member, or nursing staff), time reference or look-back period (e.g., past day, past hour, from prehospitalization condition), symptom or sign to be assessed, and coding or response categories. The list of source instruments from which items were adapted is detailed in Appendix B.…”

Section: Methodsmentioning

confidence: 99%

“…After assembling a set of 303 items, the expert panel met to come to a consensus regarding items to include in our field survey. Panelists reviewed items for unique content, clarity (e.g., avoiding double-barreled questions), alignment with the definition of the domains provided by our external expert panel [10], and suitability for use among older hospitalized patients. This resulted in the identification of a set of 103 items for the assessment of delirium severity (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…An expert panel of delirium researchers tasked with identifying domains and indicators of delirium severity revealed several characteristics of an ideal instrument. This includes broad domain coverage across delirium symptoms, high construct and predictive validity, yielding diagnosis by a severity rating and criteria, quick administration, and ease of use by minimally trained raters [10]. This review indicated that high-quality delirium severity instruments should ultimately have immediate relevant application to clinical care and quality improvement efforts.…”

Section: Introductionmentioning

confidence: 99%

“…Through the Better Assessment of Illness (BASIL) study, we undertook rigorous synthesis and development activities focusing on measurement of delirium severity that builds on the characteristics identified from the expert panel [10], with the ultimate goal of developing new instruments to measure delirium severity as a multidimensional construct. Specifically, the goal of this paper is to report our selection of domains and selection/development of new items guided by psychometric analysis of data derived from a field study (the BASIL study).…”

Section: Introductionmentioning

confidence: 99%

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New Delirium Severity Indicators: Generation and Internal Validation in the Better Assessment of Illness (BASIL) Study

Vasunilashorn

Tommet

Fong

et al. 2020

Dement Geriatr Cogn Disord

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Background: Delirium is a common and preventable geriatric syndrome. Moving beyond the binary classification of delirium present/absent, delirium severity represents a potentially important outcome for evaluating preventive and treatment interventions and tracking the course of patients. Although several delirium severity assessment tools currently exist, most have been developed in the absence of advanced measurement methodology and have not been evaluated with rigorous validation studies. Objective: We aimed to report our development of new delirium severity items and the results of item reduction and selection activities guided by psychometric analysis of data derived from a field study. Methods: Building on our literature review of delirium instruments and expert panel process to identify domains of delirium severity, we adapted items from existing delirium severity instruments and generated new items. We then fielded these items among a sample of 352 older hospitalized patients. Results: We used an expert panel process and psychometric data analysis techniques to narrow a set of 303 potential items to 17 items for use in a new delirium severity instrument. The 17-item set demonstrated good internal validity and favorable psychometric charac-S.K. Inouye and R.N. Jones contributed equally to this work. For the BASIL Study Team see Appendix A.

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“…This was a local expert panel, and it was distinct from the external expert panel that participated in the identification and definition of content domains [c.f. 10].…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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New Delirium Severity Indicators: Generation and Internal Validation in the Better Assessment of Illness (BASIL) Study

Vasunilashorn

Tommet

Fong

et al. 2020

Dement Geriatr Cogn Disord

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Psychometric Properties of a Delirium Severity Score for Older Adults and Association With Hospital and Posthospital Outcomes

et al. 2022

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Key Points Question Are scores on a delirium severity measure that was developed using advanced psychometric approaches associated with in-hospital and posthospital clinical outcomes? Findings In this cohort study of older patients (aged ≥70 years), patients in the highest delirium severity score short form group (scores 6-9) had longer mean length of stay (13.3 vs 6.9 days), greater in-hospital costs ($57 700 vs $34 200), higher 1-year costs ($168 700 vs $106 500), and increased mortality at 1 year (50% vs 17%) compared with patients in the lowest delirium severity score short form group (score 0). Meaning These findings suggest that the delirium severity score provides an approach for measuring delirium severity that is associated with adverse clinical outcomes and that the delirium severity score may help advance patient-centered care for delirium.

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Advancing specificity in delirium: The delirium subtyping initiative

Bowman¹,

Brummel

Caplan

et al. 2023

Alzheimer's & Dementia

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BACKGROUNDDelirium, a common syndrome with heterogeneous etiologies and clinical presentations, is associated with poor long‐term outcomes. Recording and analyzing all delirium equally could be hindering the field's understanding of pathophysiology and identification of targeted treatments. Current delirium subtyping methods reflect clinically evident features but likely do not account for underlying biology.METHODSThe Delirium Subtyping Initiative (DSI) held three sessions with an international panel of 25 experts.RESULTSMeeting participants suggest further characterization of delirium features to complement the existing Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision diagnostic criteria. These should span the range of delirium‐spectrum syndromes and be measured consistently across studies. Clinical features should be recorded in conjunction with biospecimen collection, where feasible, in a standardized way, to determine temporal associations of biology coincident with clinical fluctuations.DISCUSSIONThe DSI made recommendations spanning the breadth of delirium research including clinical features, study planning, data collection, and data analysis for characterization of candidate delirium subtypes.Highlights Delirium features must be clearly defined, standardized, and operationalized. Large datasets incorporating both clinical and biomarker variables should be analyzed together. Delirium screening should incorporate communication and reasoning.

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Use of an expert panel to identify domains and indicators of delirium severity

Cited by 9 publications

References 20 publications

New Delirium Severity Indicators: Generation and Internal Validation in the Better Assessment of Illness (BASIL) Study

New Delirium Severity Indicators: Generation and Internal Validation in the Better Assessment of Illness (BASIL) Study

Psychometric Properties of a Delirium Severity Score for Older Adults and Association With Hospital and Posthospital Outcomes

Advancing specificity in delirium: The delirium subtyping initiative

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