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

Abstract

Background: Delirium is an acute disturbance characterized by fluctuating symptoms related to attention, awareness and recognition. Especially for elderly patients, delirium is frequently associated with high hospital costs and resource consumption, worse functional deterioration and increased mortality rates. Early recognition of risk factors and delirium symptoms enables medical staff to prevent or treat negative effects. Most studies examining screening instruments for delirium were conducted in intensive care units and surgical wards, and rarely in general medical wards. The aim of the study is to validate the Nursing Delirium Screening Scale (Nu-DESC) and the Delirium Observation Screening Scale (DOS) in general medical wards in a German tertiary care hospital, considering predisposing delirium risk factors in patients aged 65 and older. Methods: The prospective observational study including 698 patients was conducted between May and August 2018 in two neurological and one cardiology ward. During their shifts, trained nurses assessed all patients aged 65 or older for delirium symptoms using the Nu-DESC and the DOS. Delirium was diagnosed according to the DSM-5 criteria by neurologists. Patient characteristics and predisposing risk factors were obtained from the digital patient management system. Descriptive and bivariate statistics were computed. Results: The study determined an overall delirium occurrence rate of 9.0%. Regarding the DOS, sensitivity was 0.94, specificity 0.86, PPV 0.40 NPV 0.99 and regarding the Nu-DESC, sensitivity was 0.98, specificity 0.87, PPV 0.43, NPV 1.00. Several predisposing risk factors increased the probability of delirium: pressure ulcer risk OR: 17.3; falls risk OR: 14.0; immobility OR: 12.7; dementia OR: 5.38.

Delirium in Critically Ill Patients with and without COVID-19—A Retrospective Analysis

“…Other relevant characteristics such as age and SAPS2 were also similar to those in the referred study, showing the representativity of our results. The Nudesc score, used to diagnose delirium in our study, is a validated tool with high specificity for delirium [ 14 , 15 , 16 ]. Known predictors of delirium (age, dementia, alcohol abuse) correlated nicely with delirium detected in this registry and patients with delirium had longer ICU stays.…”

“…The Nudesc is routinely assessed by specially trained nurses for all patients on our ICU at least three times a day. The NuDesc is approved, easy to use and has a reported sensitivity (93–98%) and specificity (81–87%) for diagnosis [ 14 , 15 , 16 ]. Delirium positive days were defined as the ratio of days with a positive delirium assessment to all days on which an assessment was possible.…”

Incidence and predictors of delirium on the intensive care unit after acute myocardial infarction, insight from a retrospective registry

“…Nevertheless, Bergjan et al showed a high sensitivity (98%) and specificity (87%) in elderly patients in general medical wards. 36 Although data exists showing good performance of the NuDesc when compared to other screening scores, we cannot exclude that findings might have been different when using another score for screening. 19,37 Likewise, there have been studies suggesting that the modified RASS as suggested by the Veteran's Affairs Delirium Working Group might have been even more suited than the RASS for sub classification of delirium although RASS itself is highly associated with delirium.…”

Tempo de permanência prolongado na emergência associado à delirium em idosos: revisão sistemática

“…O estudo observacional prospectivo, realizado em 2020, com 745 pacientes, com 65 anos ou mais, demostrou que os pacientes que desenvolveram delirium era mais velhos e permaneciam por mais tempo nas unidades médicas quando comparado ao grupo de pacientes não delirantes. As principais causas de admissão hospitalar desses pacientes foram as doenças do sistema circulatório, 73%, e do sistema nervoso, cerca de 16%, seguidas de doenças do sistema respiratório e doenças infecciosas e parasitárias, ambas com a média de 3% das admissões (Bergjan et al, 2020).…”