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17. Delirium Item Bank: Utilization to Evaluate and Create Delirium Instruments.

Author

Helfand, Benjamin K.I., Tommet, Douglas, Detroyer, Elke, Milisen, Koen, Adamis, Dimitrios, Metzger, Eran D., Marcantonio, Edward R., Boudreaux, Edwin D., Inouye, Sharon K., and Jones, Richard N.

Subjects
DIAGNOSIS of delirium, COGNITION disorders, RESEARCH methodology evaluation, RESEARCH methodology, PSYCHOMETRICS, CLASSIFICATION of mental disorders, SENSITIVITY & specificity (Statistics), SECONDARY analysis
Abstract

Introduction: The large number of heterogeneous instruments in active use for identification of delirium prevents direct comparison of studies and the ability to combine results. In a recent systematic review we performed, we recommended four commonly used and well-validated instruments and subsequently harmonized them using advanced psychometric methods to develop an item bank, the Delirium Item Bank (DEL-IB). The goal of the present study was to find optimal cut-points on four existing instruments and to demonstrate use of the DEL-IB to create new instruments. Methods: We used a secondary analysis and simulation study based on data from three previous studies of hospitalized older adults (age 65+ years) in the USA, Ireland, and Belgium. The combined dataset included 600 participants, contributing 1,623 delirium assessments, and an overall incidence of delirium of about 22%. The measurements included the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnostic criteria for delirium, Confusion Assessment Method (long form and short form), Delirium Observation Screening Scale, Delirium Rating Scale-Revised-98 (total and severity scores), and Memorial Delirium Assessment Scale (MDAS). Results: We identified different cut-points for each existing instrument to optimize sensitivity or specificity, and compared instrument performance at each cut-point to the author-defined cut-point. For instance, the cut-point on the MDAS that maximizes both sensitivity and specificity was at a sum score of 6 yielding 89% sensitivity and 79% specificity. We then created four new example instruments (two short forms and two long forms) and evaluated their performance characteristics. In the first example short form instrument, the cut-point that maximizes sensitivity and specificity was at a sum score of 3 yielding 90% sensitivity, 81% specificity, 30% positive predictive value, and 99% negative predictive value. Discussion/Conclusion: We used the DEL-IB to better understand the psychometric performance of widely used delirium identification instruments and scorings, and also demonstrated its use to create new instruments. Ultimately, we hope that the DEL-IB might be used to create optimized delirium identification instruments and to spur the development of a unified approach to identify delirium. [ABSTRACT FROM AUTHOR]

Published
2022
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21. Nursing aspects of delirium prevention and detection in hospitalized patients : Verpleegkundige aspecten in de preventie en vroegtijdige detectie van delirium bij gehospitaliseerde patiënten

Author

Detroyer, Elke, Joosten, Etienne, and Milisen, Koen

Subjects
mental disorders, behavioral disciplines and activities, nervous system diseases
Abstract

Delirium is the most common neurocognitive complication in the hospital, affecting 11% to 68% of surgical, 29% to 64% of medical, and up to 88% of intensive care and palliative care unit patients. To date, prevention through modification of identified risk factors and an early detection are the most effective strategies to avoid the onset of delirium and its associated complications. Within these strategies, nurses play a pivotal role. Indeed, because of their continuous contacts with patients, they are key in identifying and targeting risk factors and observing early signs of delirium such as acute disturbances and fluctuations in consciousness, cognition and behaviour. However, delirium remains poorly prevented and frequently unrecognized in daily practice. Hence, permanent investments in delirium prevention and early detection are crucial to optimize delirium management in day-to-day care. This PhD project aimed to investigate three important nursing aspects of delirium prevention and detection by 1) determining if preoperative psychological factors (i.e. anxiety, depression) are risk factors for postoperative delirium in older cardiac surgery and hip fracture patients, 2) evaluating the psychometrics and ease-of-use of two observation-based delirium screening tools for the detection of delirium when performed by bedside nurses in routine daily practice, and 3) by investigating the impact of delirium education through a newly developed e-learning tool on nursing and patient outcomes in delirium care. nrpages: 190 status: published

Published
2017

23. Is preoperative state anxiety a risk factor for postoperative delirium among elderly hip fracture patients?

Author

Van Grootven, Bastiaan, Detroyer, Elke, Devriendt, Els, Sermon, An, Deschodt, Mieke, Flamaing, Johan, Dubois, Christophe, and Milisen, Koen

Subjects
mental disorders
Abstract

AIM: To determine if preoperative state anxiety is a risk factor for postoperative delirium in older hip fracture patients. METHODS: A secondary data analysis comprising data from a prospective non-randomized trial including 86 patients with a hip fracture aged 65 years and older was carried out. State anxiety was measured preoperatively using the State-Trait Anxiety Inventory. Delirium and its severity was measured pre- and postoperatively (day 1, 3, 5, 8) by trained research nurses using the Confusion Assessment Method and Delirium Index. RESULTS: A total of 24 patients (27.9%) developed delirium postoperatively. Preoperative state anxiety (State-Trait Anxiety Inventory) was not associated with postoperative delirium (rb = 0.135, P = 0.353), duration of postoperative delirium (rho = 0.038, P = 0.861) or severity of postoperative delirium (rho = 0.153, P = 0.160). Independent predictors of postoperative delirium were lower MMSE scores (OR 0.75, 95% CI 0.60-0.95, P = 0.015), osteosynthesis surgery (OR 3.66, 95% CI 1.02-13.15, P = 0,047) and lowest intraoperative diastolic blood pressure (OR 0.92, 95% CI 0.85-0.99, P = 0.031). CONCLUSION: No relationship between state anxiety and postoperative delirium was found, but significant methodological hurdles were observed and discussed providing important groundwork for further research in this area. Further research should focus on reliable measurement of state anxiety in cognitively impaired older populations. Geriatr Gerontol Int 2016; 16: 948-955. ispartof: Geriatrics and Gerontology International vol:16 issue:8 pages:948-955 ispartof: location:Japan status: published

Published
2016

24. The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer

Author

Boustani, Malaz, Olofsson, Birgitta, Thomas, Christine, Young, John, Davis, Daniel, Laurila, Jouko, Page, Valerie, Teodorczuk, Andrew, Kamholz, Barbara, Agar, Meera, Meagher, David, Spiller, Juliet, Schieveld, Jan, Milisen, Koen, de Rooij, Sophia, van Munster, Barbara, Kreisel, Stefan, Cerejeira, Joaquim, Hasemann, Wolfgang, Wilson, Dan, Cunningham, Colm, Morandi, Alessandro, Slooter, Arjen, Detroyer, Elke, Caraceni, Augusto, MacLullich, Alasdair, Rudolph, Jim, Shaughnessy, Marianne, Gruber-Baldini, Ann, Alici, Yesne, Arora, Rakesh C, Campbell, Noll, Flaherty, Joseph, Gordon, Sharon, Maldonado, Jose R, Pandharipande, Pratik, Parks, Joyce, Waszynski, Christine, Khan, Babar, and Neufeld, Karin

Subjects
Diagnostic and Statistical Manual of Mental Disorders, Consciousness, mental disorders, Delirium, Attention, Arousal
Abstract

Background: Delirium is a common and serious problem among acutely unwell persons. Alhough linked to higher rates of mortality, institutionalisation and dementia, it remains underdiagnosed. Careful consideration of its phenomenology is warranted to improve detection and therefore mitigate some of its clinical impact. The publication of the fifth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) provides an opportunity to examine the constructs underlying delirium as a clinical entity. Discussion: Altered consciousness has been regarded as a core feature of delirium; the fact that consciousness itself should be physiologically disrupted due to acute illness attests to its clinical urgency. DSM-5 now operationalises ‘consciousness’ as ‘changes in attention’. It should be recognised that attention relates to content of consciousness,but arousal corresponds to level of consciousness. Reduced arousal is also associated with adverse outcomes. Attention and arousal are hierarchically related; level of arousal must be sufficient before attention can be reasonably tested. Summary: Our conceptualisation of delirium must extend beyond what can be assessed through cognitive testing (attention) and accept that altered arousal is fundamental. Understanding the DSM-5 criteria explicitly in this way offers the most inclusive and clinically safe interpretation. ispartof: BMC Medicine vol:12 issue:1 ispartof: location:England status: published

Published
2014

32. Is preoperative state anxiety a risk factor for postoperative delirium among elderly hip fracture patients?

Author

Van Grootven B, Detroyer E, Devriendt E, Sermon A, Deschodt M, Flamaing J, Dubois C, and Milisen K

Subjects
Aged, Aged, 80 and over, Anxiety psychology, Arthroplasty, Replacement, Hip methods, Belgium, Delirium epidemiology, Female, Follow-Up Studies, Fracture Fixation, Intramedullary methods, Fracture Fixation, Intramedullary psychology, Geriatric Assessment methods, Hip Fractures diagnosis, Humans, Logistic Models, Male, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Preoperative Period, Prospective Studies, Risk Assessment, Statistics, Nonparametric, Treatment Outcome, Anxiety diagnosis, Arthroplasty, Replacement, Hip psychology, Delirium diagnosis, Hip Fractures psychology, Hip Fractures surgery
Abstract

Aim: To determine if preoperative state anxiety is a risk factor for postoperative delirium in older hip fracture patients., Methods: A secondary data analysis comprising data from a prospective non-randomized trial including 86 patients with a hip fracture aged 65 years and older was carried out. State anxiety was measured preoperatively using the State-Trait Anxiety Inventory. Delirium and its severity was measured pre- and postoperatively (day 1, 3, 5, 8) by trained research nurses using the Confusion Assessment Method and Delirium Index., Results: A total of 24 patients (27.9%) developed delirium postoperatively. Preoperative state anxiety (State-Trait Anxiety Inventory) was not associated with postoperative delirium (rb  = 0.135, P = 0.353), duration of postoperative delirium (rho = 0.038, P = 0.861) or severity of postoperative delirium (rho = 0.153, P = 0.160). Independent predictors of postoperative delirium were lower MMSE scores (OR 0.75, 95% CI 0.60-0.95, P = 0.015), osteosynthesis surgery (OR 3.66, 95% CI 1.02-13.15, P = 0,047) and lowest intraoperative diastolic blood pressure (OR 0.92, 95% CI 0.85-0.99, P = 0.031)., Conclusion: No relationship between state anxiety and postoperative delirium was found, but significant methodological hurdles were observed and discussed providing important groundwork for further research in this area. Further research should focus on reliable measurement of state anxiety in cognitively impaired older populations. Geriatr Gerontol Int 2016; 16: 948-955., (© 2015 Japan Geriatrics Society.)

Published
2016
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