Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study

Hendry, K., Quinn, T. J. , Evans, J. , Scortichini, V., Miller, H., Burns, J., Cunnington, A. and Stott, D. J. (2016) Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study. Age and Ageing, 45(6), pp. 832-837. (doi: 10.1093/ageing/afw130) (PMID:27503794)

Abstract

Introduction: screening all unscheduled older adults for delirium is recommended in national guidelines, but there is no consensus on how to perform initial assessment. Aim: to evaluate the test accuracy of five brief cognitive assessment tools for delirium diagnosis in routine clinical practice. Methods: a consecutive cohort of non-elective, elderly care (older than 65 years) hospital inpatients admitted to a geriatric medical assessment unit of an urban teaching hospital. Reference assessments were clinical diagnosis of delirium performed by elderly care physicians. Routine screening tests were: Abbreviated Mental Test (AMT-10, AMT-4), 4 A's Test (4AT), brief Confusion Assessment Method (bCAM), months of the year backwards (MOTYB) and informant Single Question in Delirium (SQiD). Results: we assessed 500 patients, mean age 83 years (range = 66−101). Clinical diagnoses were: 93 of 500 (18.6%) definite delirium, 104 of 500 (20.8%) possible delirium and 277 of 500 (55.4%) no delirium; 266 of 500 (53.2%) were identified as definite or possible dementia. For diagnosis of definite delirium, AMT-4 (cut-point < 3/4) had a sensitivity of 92.7% (95% confidence interval (CI): 84.8–97.3), with a specificity of 53.7% (95% CI: 48.1–59.2); AMT-10 (<4/10), MOTYB (<4/12) and SQiD showed similar performance. bCAM had a sensitivity of 70.3% (95% CI: 58.5–80.3) with a specificity of 91.4% (95% CI: 87.7–94.3). 4AT (>4/12) had a sensitivity of 86.7% (95% CI: 77.5–93.2) and specificity of 69.5% (95% CI: 64.4–74.3). Conclusions: short screening tools such as AMT-4 or MOTYB have good sensitivity for definite delirium, but poor specificity; these tools may be reasonable as a first stage in assessment for delirium. The 4AT is feasible and appears to perform well with good sensitivity and reasonable specificity.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cunnington, Dr Anne-Louise and Hendry, Miss Kirsty and Evans, Professor Jonathan and Scortichini, Dr Valeria and Burns, Dr Jennifer and Quinn, Professor Terry and Stott J, Professor David
• Authors: Hendry, K., Quinn, T. J., Evans, J., Scortichini, V., Miller, H., Burns, J., Cunnington, A., and Stott, D. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Age and Ageing
• Publisher: Oxford University Press
• ISSN: 0002-0729
• ISSN (Online): 1468-2834
• Published Online: 08 August 2016
• Copyright Holders: Copyright © 2016 Oxford University Press
• First Published: First published in Age and Ageing 45(6):832-837
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher