Validation of the delirium observation screening scale in a hospitalized older population

Gavinski, Katherine; Carnahan, Ryan M.; Weckmann, Michelle T.

doi:10.1002/jhm.2580

Cited by 54 publications

(59 citation statements)

References 18 publications

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“…Baseline medical and surgical history and demographic information were obtained from medical records and patient interviews. For measurement of clinical symptoms of delirium, the CAM-ICU, 18,19 the DRS-R-98, 20 and Delirium Observation Screening Scale (DOSS) 28,29 were used. For the assessment of baseline cognitive function, the Montreal Cognitive Assessment (MoCA) 30 was used.…”

Section: Variables and Data Sourcesmentioning

confidence: 99%

Identification of Patients With High Mortality Risk and Prediction of Outcomes in Delirium by Bispectral EEG

Shinozaki¹,

Bormann²,

Chan³

et al. 2019

J. Clin. Psychiatry

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Background: Delirium is common and dangerous, yet underdetected and undertreated. Current screening questionnaires are subjective and ineffectively implemented in busy hospital workflows. Electroencephalography (EEG) can objectively detect the diffuse slowing characteristic of delirium, but it is not suitable for high-throughput screening due to size, cost, and the expertise required for lead placement and interpretation. This study hypothesized that an efficient and reliable point-of-care EEG device for high-throughput screening could be developed. Methods: This prospective study, which measured bispectral EEG (BSEEG) from elderly inpatients to assess their outcomes, was conducted at the University of Iowa Hospitals and Clinics from January 2016 to October 2017. A BSEEG score was defined based on the distribution of 2,938 EEG recordings from the 428 subjects who were assessed for delirium; primary outcomes measured were hospital length of stay, discharge disposition, and mortality. Results: A total of 274 patients had BSEEG score data available for analysis. Delirium and BSEEG score had a significant association (P < .001). Higher BSEEG scores were significantly correlated with length of stay (P < .001 unadjusted, P = .001 adjusted for age, sex, and Charlson Comorbidity Index [CCI] score) as well as with discharge not to home (P < .01). Hazard ratio for survival controlling for age, sex, CCI score, and delirium status was 1.35 (95% CI,1.04 to 1.76; P = .025). Conclusions: In BSEEG, an efficient and reliable device that provides an objective measurement of delirium status was developed. The BSEEG score is significantly associated with pertinent clinical outcomes of mortality, hospital length of stay, and discharge disposition. The BSEEG score better predicts mortality than does clinical delirium status. This study identified a previously unrecognized subpopulation of patients without clinical features of delirium who are at increased mortality risk.

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Section: Variables and Data Sourcesmentioning

confidence: 99%

Identification of Patients With High Mortality Risk and Prediction of Outcomes in Delirium by Bispectral EEG

Shinozaki¹,

Bormann²,

Chan³

et al. 2019

J. Clin. Psychiatry

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“…It has been validated for use in cardiac surgery (Koster, Hensens, Oosterveld, Wijma, & van der Palen, 2009), palliative care (Detroyer et al, 2014), and community hospice patients (Jorgensen, Carnahan, & Weckmann, 2017). It has also been validated in an acute care setting in the United States (Gavinski, Carnahan, & Weckmann, 2016). Currently, validation in British nursing homes is ongoing (Teale et al, 2016).…”

mentioning

confidence: 99%

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

Hasemann¹,

Tolson²,

Godwin³

et al. 2018

J Gerontol Nurs

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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.

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“…[30] The scale has been translated in English and Dutch. [31] Information about delirium symptoms from medical and nursing records considering the previous 24 hours was taken into account as well. If delirium was suspected, a psychiatrist was consulted to perform a full mental examination and to evaluate the patient for delirium using the criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) [5]…”

Section: Methodsmentioning

confidence: 99%

Preoperative CSF Melatonin Concentrations and the Occurrence of Delirium in Older Hip Fracture Patients: A Preliminary Study

et al. 2016

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BackgroundDelirium is characterized by disturbances in circadian rhythm. Melatonin regulates our circadian rhythm. Our aim was to compare preoperative cerebrospinal fluid (CSF) melatonin levels in patients with and without postoperative delirium.MethodsProspective cohort study with hip fracture patients ≥ 65 years who were acutely admitted to the hospital for surgical treatment and received spinal anaesthesia. CSF was collected after cannulation, before administering anaesthetics. Melatonin was measured by radioimmunoassay (RIA). Data on delirium was obtained from medical and nursing records. Nurses screened every shift for delirium using the Delirium Observation Screening Scale (DOSS). If the DOSS was ≥3, a psychiatrist was consulted to diagnose possible delirium using the DSM-IV criteria. At admission, demographic data, medical history, and information on functional and cognitive status was obtained.ResultsSeventy-six patients met the inclusion criteria. Sixty patients were included in the analysis. Main reasons for exclusion were technical difficulties, insufficient CSF or exogenous melatonin use. Thirteen patients (21.7%) experienced delirium during hospitalisation. Baseline characteristics did not differ between patients with and without postoperative delirium. In patients with and without postoperative delirium melatonin levels were 12.88 pg/ml (SD 6.3) and 11.72 pg/ml (SD 4.5) respectively, p-value 0.47. No differences between patients with and without delirium were found in mean melatonin levels in analyses stratified for cognitive impairment or age.ConclusionPreoperative CSF melatonin levels did not differ between patients with and without postoperative delirium. This suggests that, if disturbances in melatonin secretion occur, these might occur after surgery due to postoperative inflammation.

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Validation of the delirium observation screening scale in a hospitalized older population

Cited by 54 publications

References 18 publications

Identification of Patients With High Mortality Risk and Prediction of Outcomes in Delirium by Bispectral EEG

Identification of Patients With High Mortality Risk and Prediction of Outcomes in Delirium by Bispectral EEG

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

Preoperative CSF Melatonin Concentrations and the Occurrence of Delirium in Older Hip Fracture Patients: A Preliminary Study

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