Validation of the Delirium Diagnostic Tool-Provisional (DDT-Pro) With Medical Inpatients and Comparison With the Confusion Assessment Method Algorithm
| Autor: | Daniel R. Zaraza, María Victoria Ocampo, Jacob Kean, Paula T. Trzepacz, Paola A. Serna, Adolfo Zuluaga, Carolina López, Esteban Sepulveda, Alejandra M. Giraldo, Juan D. Velásquez-Tirado, José Franco |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Nursing assessment Hospital Departments Sensitivity and Specificity 03 medical and health sciences 0302 clinical medicine mental disorders medicine Internal Medicine Dementia Humans 030212 general & internal medicine Prospective Studies Psychiatry Confusion Aged Aged 80 and over Psychiatric Status Rating Scales Inpatients business.industry Delirium Reproducibility of Results medicine.disease 030227 psychiatry Psychiatry and Mental health Cross-Sectional Studies Assessment methods Psychiatric status rating scales Female Neurology (clinical) medicine.symptom business |
| Zdroj: | The Journal of neuropsychiatry and clinical neurosciences. 32(3) |
| ISSN: | 1545-7222 |
| Popis: | Delirium remains underdetected as a result of its broad constellation of symptoms and the inadequate neuropsychiatric expertise of most medical-surgical clinicians. Brief, accurate tools are needed to enhance detection.The authors extended validation of the Delirium Diagnostic Tool-Provisional (DDT-Pro), originally validated in a study of inpatients with traumatic brain injury for diagnosis of delirium by nonexpert clinicians, for 200 general medical inpatients in Colombia. The three structured, quantitatively rated items in DDT-Pro represent the three core delirium domains.High interrater reliability between physician and nurse (0.873) administrators, internal consistency (0.81), and content validity were found. Compared with independent reference standard diagnosis with DSM-5 or the Delirium Rating Scale-Revised-98, the area under the receiver operating characteristic (ROC) curve (global diagnostic accuracy) range was 93.8%-96.3%. ROC analysis revealed the same cutoff score (≤6) as that for the original study, with somewhat lower sensitivities of 88.0%-90.0% and specificities of 85.3%-81.2% (independent expert physician or nurse ratings). Even when rated by a trained expert physician, the original version of the Confusion Assessment Method algorithm (CAM-A) performed moderately, with lower sensitivities (61.8%-70.0%) than the DDT-Pro (88.0%-100%) and somewhat higher specificities (84.8%-95.3% versus 67.4%-86.7%), with values depending on dementia status, reference standard, and rater type. Accuracies for the DDT-Pro and CAM-A were comparable (DDT-Pro: 83.0%-87.5% versus CAM-A: 87.5%-88.5%), although lower in the dementia subgroup, especially for CAM-A. However, these tools were significantly discordant, especially in negative cases, which suggests that they do not detect diagnosis of patients in the same way.The DDT-Pro had high validity and reliability in provisional delirium diagnosis by physicians and nonexpert clinicians, although further validation is warranted before widespread use can be recommended. |
| Databáze: | OpenAIRE |
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