Screening for delirium within the interRAI acute care assessment system

Salih, S. A., Paul, S., Klein, K., Lakhan, P. and Gray, L. (2012) Screening for delirium within the interRAI acute care assessment system. Journal of Nutrition, Health and Aging, 16 8: 695-700. doi:10.1007/s12603-012-0074-4

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Author Salih, S. A.
Paul, S.
Klein, K.
Lakhan, P.
Gray, L.
Title Screening for delirium within the interRAI acute care assessment system
Journal name Journal of Nutrition, Health and Aging   Check publisher's open access policy
ISSN 1279-7707
Publication date 2012-10
Sub-type Article (original research)
DOI 10.1007/s12603-012-0074-4
Volume 16
Issue 8
Start page 695
End page 700
Total pages 6
Place of publication Paris, France
Publisher Editions SERDI
Collection year 2013
Language eng
Formatted abstract
Objectives: To develop and validate a screening strategy for delirium within the inter RAI Acute Care comprehensive assessment system.
Design: Prospective validation cohort study.
Setting: Acute general medical wards in two acute care metropolitan hospitals in Brisbane, Australia.
Participants: Two hundreds thirty-nine subjects with and without delirium, aged 70 and older.
Measurements: Trained research nurses assessed subjects within 36 hours of hospital admission using the inter-RAI acute care (AC) system which includes four observational delirium items: Acute change mental status from baseline (ACMS), mental function varies over the course of the day (MFV), episode of disorganised speech (EDS), and easily distracted (ED). Geriatricians assessed subjects face to face within 4 hours of nurses’ assessment using the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria and clinical judgement to determine delirium presence. Based on the performance of each delirium feature and to achieve highest predictive accuracy, a combination algorithm of either ACMS or MFV was developed and compared with the reference standard diagnosis determined by geriatricians. Results: Geriatricians diagnosed delirium in 52 of 239 (21.7%) subjects aged 70–102 years. The area under the receiver operator characteristics (AUC) for inter RAI-AC delirium screener algorithm was 0.87 (95% CI; 0.80, 0.93), sensitivity 82%, specificity 91%, positive and negative predictive value of 0.72% and 95%, and likelihood ratio of 9.6 achieving the highest predictive accuracy of all possible combination of 4 delirium features. Underlying pre-morbid cognitive impairment did not undermine validity of the screening strategy, AUC 0.85 (95% CI; 0.74, 0.95), sensitivity 90% and specificity 69%.
Conclusion: The interRAI AC delirium screening strategy is a valid measure of delirium in older subjects in acute medical wards.
Keyword Delirium screener
Diagnostic test performance
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Public Health Publications
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 8 times in Thomson Reuters Web of Science Article | Citations
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Created: Thu, 13 Sep 2012, 15:47:26 EST by Sanjoy Paul on behalf of School of Public Health