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Research paper
Attention! A good bedside test for delirium?
  1. Niamh A O'Regan1,
  2. Daniel J Ryan1,
  3. Eve Boland2,
  4. Warren Connolly2,
  5. Ciara McGlade1,
  6. Maeve Leonard3,
  7. Josie Clare4,
  8. Joseph A Eustace5,
  9. David Meagher6,7,
  10. Suzanne Timmons1
  1. 1Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
  2. 2Cork University Hospital, Cork, Ireland
  3. 3Department of Psychiatry, University of Limerick, Limerick, Ireland
  4. 4Department of Geriatric Medicine, Waterford Regional Hospital, Waterford, Ireland
  5. 5HRB Clinical Research Facility at UCC, University College Cork, Cork, Ireland
  6. 6Department of Psychiatry, University of Limerick, Limerick, Ireland
  7. 7Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  1. Correspondence to Dr Niamh O'Regan, Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, St Finbarr's Hospital, Douglas Road, Cork, Ireland; niamhoregan78{at}yahoo.co.uk

Abstract

Background Routine delirium screening could improve delirium detection, but it remains unclear as to which screening tool is most suitable. We tested the diagnostic accuracy of the following screening methods (either individually or in combination) in the detection of delirium: MOTYB (months of the year backwards); SSF (Spatial Span Forwards); evidence of subjective or objective ‘confusion’.

Methods We performed a cross-sectional study of general hospital adult inpatients in a large tertiary referral hospital. Screening tests were performed by junior medical trainees. Subsequently, two independent formal delirium assessments were performed: first, the Confusion Assessment Method (CAM) followed by the Delirium Rating Scale-Revised 98 (DRS-R98). DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria were used to assign delirium diagnosis. Sensitivity and specificity ratios with 95% CIs were calculated for each screening method.

Results 265 patients were included. The most precise screening method overall was achieved by simultaneously performing MOTYB and assessing for subjective/objective confusion (sensitivity 93.8%, 95% CI 82.8 to 98.6; specificity 84.7%, 95% CI 79.2 to 89.2). In older patients, MOTYB alone was most accurate, whereas in younger patients, a simultaneous combination of SSF (cut-off 4) with either MOTYB or assessment of subjective/objective confusion was best. In every case, addition of the CAM as a second-line screening step to improve specificity resulted in considerable loss in sensitivity.

Conclusions Our results suggest that simple attention tests may be useful in delirium screening. MOTYB used alone was the most accurate screening test in older people.

  • ATTENTION
  • COGNITION
  • NEUROPSYCHIATRY

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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