Validation of the Sour Seven Questionnaire for screening delirium in hospitalized seniors by informal caregivers and untrained nurses

Abstract

BackgroundDelirium is a common condition in hospitalized seniors that nonetheless often goes undetected by nurses or is delayed in being detected which negatively impacts quality of care and outcomes. We sought to develop a new screening tool for delirium, The Sour Seven Questionnaire, a 7-item questionnaire suitable to be completed from informal or untrained caregiver observation. The study aimed to develop the scoring criteria for a positive delirium screen and assess concurrent validity of the questionnaire against a geriatric psychiatrist’s assessment.MethodsA pilot study of 80 hospitalized seniors over age 65 recruited from three units (2 medical, 1 orthopedic). Participants were assessed using the Confusion Assessment Method (CAM) with a brief cognitive screen and the Sour Seven Questionnaire posed to the appointed informal caregiver (family member) or untrained nurse for up-to 7 days. Subjects testing positive on the CAM and a random sample of negatively CAM screened subjects were assessed by the geriatric psychiatrist.ResultsFrom 80 participants, 21 screened positive for delirium on the CAM. 18 of the 21 CAM positive screens were diagnosed to have delirium by the geriatric psychiatrist, and 17 of the 18 randomly assigned negative CAM screens were confirmed as not having delirium. From the questionnaires on these 39 participants, weighted scoring for each of the 7 questions of the Sour Seven Questionnaire was developed based on their relative risks for correctly predicting delirium when compared to the geriatric psychiatrist’s clinical assessment. Total scoring of the questionnaire resulted in the following positive predictive values for delirium: 89 % with a total score of 4 (sensitivity 89.5 %, specificity 90 %), and 100 % with a total score of 9 (sensitivity 63.2 %, specificity 100 %). Comparison between scoring on questionnaires posed to informal caregivers versus untrained nurses showed no differences.ConclusionA weighted score of 4 in the Sour Seven Questionnaire has concurrent validity as a screening tool for delirium and a score of 9 is diagnostic for delirium. The Sour Seven Questionnaire is the first screening tool for delirium shown to be suitable for use by informal caregivers and untrained nurses in hospitalized seniors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0217-2) contains supplementary material, which is available to authorized users.

Family Identification of Delirium in the Emergency Department in Patients With and Without Dementia: Validity of the Family Confusion Assessment Method (FAM‐CAM)

“…There are three existing tools that can be independently completed by family caregivers—the FAM‐CAM, the Informant Assessment of Geriatric Delirium (I‐AGeD), and the Sour Seven . A strength of the FAM‐CAM is that it allows families to systematically report their observations of features of delirium, as well as to detail when the changes (ie, whether the changes were acute or progressive) began and if they have been getting better or worse (items 8‐11).…”

Validation of Caregiver‐Centered Delirium Detection Tools: A Systematic Review

“…After duplicates were removed, reviewers screened titles and abstracts of 6,076 unique citations; 5,892 citations did not meet inclusion criteria. Reviewers assessed 184 articles in full text, and 6 studies were included in the final systematic review …”

“…Three included articles evaluated 3 caregiver‐administered delirium detection tools: Family CAM (FAM‐CAM), Informant Assessment of Geriatric Delirium (I‐AGeD), and Sour Seven …”

“…The Sour Seven is a 7‐item weighted questionnaire with a maximum score of 18 . The items evaluate features of delirium, including altered awareness and attention, fluctuation, disordered thinking and behavior, impaired eating or drinking, and difficulty in mobility …”

“…A single‐center study validated the Sour Seven for use by untrained (with no formal review of the tool) caregivers and nurses in general medical and surgical hospital units . The reference standard was a psychiatric interview conducted by a geriatric psychiatrist using DSM‐IV criteria .…”