Detecting Delirium Superimposed on Dementia: Evaluation of the Diagnostic Performance of the Richmond Agitation and Sedation Scale.
Alessandro Morandi, Jin H Han, David Meagher and 7 others
PMID 27346621WHAT IT FOUND
In older patients with dementia, any abnormal RASS/m-RASS score was often right when positive but missed some cases; a score above +1 or below -1 was more often right when positive but missed more.
Key findings
01Among 645 older patients with dementia, 376 had delirium by the reference standard.
02Any RASS/m-RASS score other than 0 was 70.5% sensitive and 84.8% specific for delirium in this group.
03Using scores above +1 or below -1 made a positive result 95.5% specific for delirium, but it missed more cases.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The diagnosis of delirium and dementia was made with different tools across the five groups, so performance varied by reference standard. The dataset had a greater number of patients diagnosed with delirium using the 4AT, although performance was similar when DSM criteria were used. The study pooled previous cohorts, so it was not a single planned diagnostic accuracy study. A normal score did not exclude delirium, because the test missed some patients with delirium.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not treat a normal RASS/m-RASS score as proof there is no delirium. The test did not identify all patients with delirium, so it should prompt further assessment, not replace it.