Ultra-brief Screeners for Detecting Delirium Superimposed on Dementia.
Erika Steensma, Wenxiao Zhou, Long Ngo and 8 others
PMID 31279670WHAT IT FOUND
The best three-question screen caught 0.94 of delirium cases in hospitalized people with dementia, but only 0.42 of people without delirium were correctly ruled out.
Key findings
01The best three-item screener asked what type of place this is, had the patient say days of the week backwards, and asked whether the patient appears sleepy; it had sensitivity 0.94 and specificity 0.42.
02The three-item screener kept sensitivity above 0.80 across dementia severity, education, depression, and delirium severity strata, but specificity fell to 0.23 in moderate dementia and 0.08 in advanced dementia.
03Spelling WORLD backwards was the most sensitive single item at 0.89, but it had specificity 0.30 and a 74% positive screen rate.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The screeners were developed for patients with known dementia, so they may not work when dementia status is uncertain. The study did not show how performance differs across dementia subtypes. The sample was 94.9% Caucasian, so results may not generalize to more diverse populations. The tested items were also part of the reference standard delirium assessment, which could inflate sensitivity. These screeners were derived from secondary data and need clinical validation. Analyses used only the first day of admission, which reduced statistical power. Mental status can change over the hospital course, so the best items may not be the same each day. The best three-item screener had specificity 0.42 overall, and specificity was 0.08 in advanced dementia, so a positive screen does not confirm delirium.
Declared interests
The authors report no conflicts of interest.
The easy way to misread this
Do not treat a positive three-question screen as proof of delirium. The best screener had specificity 0.42 overall and 0.08 in advanced dementia, so a positive result still needs a validated delirium assessment.