Dataset Information

Harmonization of delirium severity instruments: a comparison of the DRS-R-98, MDAS, and CAM-S using item response theory.

ABSTRACT:

Background

This study aimed to describe the level of agreement of three commonly used delirium instruments: the Delirium Rating Scale-Revised-98 (DRS-R-98), Memorial Delirium Assessment Scale (MDAS), and Confusion Assessment Method-Severity (CAM-S).

Methods

We used data from a prospective clinical research study, in which a team of trained lay interviewers administered each instrument along with supporting interview and cognitive assessments in the same group of patients daily while in the hospital (N?=?352). We used item response theory methods to co-calibrate the instruments.

Results

The latent traits underlying the three measures, capturing the severity of a delirium assessment, had a high degree of correlation (r's?>?.82). Unidimensional factor models fit well, facilitating co-calibration of the instruments. Across instruments, the less intense symptoms were generally items reflecting cognitive impairment. Although the intensity of delirium severity for most in the sample was relatively low, many of the item thresholds for the delirium severity scales are high (i.e., in the more severe range of the latent ability distribution). This indicates that even people with severe delirium may have a low probability of endorsing the highest severity categories for many items. Co-calibration enabled us to derive crosswalks to map delirium severity scores among the delirium instruments.

Conclusion

These delirium instruments measure the same underlying construct of delirium severity. Relative locations of items may inform design of refined measurement instruments. Mapping of overall delirium severity scores across the delirium severity instruments enabled us to derive crosswalks, which allow scores to be translated across instruments, facilitating comparison and combination of delirium studies for integrative analysis.

SUBMITTER: Gross AL

PROVIDER: S-EPMC6131747 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Publications

Harmonization of delirium severity instruments: a comparison of the DRS-R-98, MDAS, and CAM-S using item response theory.

Gross Alden L AL Tommet Doug D D'Aquila Madeline M Schmitt Eva E Marcantonio Edward R ER Helfand Benjamin B Inouye Sharon K SK Jones Richard N RN

BMC medical research methodology 20180910 1

<h4>Background</h4>This study aimed to describe the level of agreement of three commonly used delirium instruments: the Delirium Rating Scale-Revised-98 (DRS-R-98), Memorial Delirium Assessment Scale (MDAS), and Confusion Assessment Method-Severity (CAM-S).<h4>Methods</h4>We used data from a prospective clinical research study, in which a team of trained lay interviewers administered each instrument along with supporting interview and cognitive assessments in the same group of patients daily whi ...[more]

PMID: 30200896

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Project description:ImportanceMeasurement of delirium severity has been recognized as highly important for tracking prognosis, monitoring response to treatment, and estimating burden of care for patients both during and after hospitalization. Rather than simply rating delirium as present or absent, the ability to quantify its severity would enable development and monitoring of more effective treatment approaches for the condition.ObjectivesTo present a comprehensive review of delirium severity instruments, conduct a methodologic quality rating of the original validation study of the most commonly used instruments, and select a group of top-rated instruments.Evidence reviewThis systematic review was conducted using literature from Embase, PsycINFO, PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature, from January 1, 1974, through March 31, 2017, with the key words delirium, severity, tests, measures, and intensity. Inclusion criteria were original articles assessing delirium severity and using a delirium-specific severity instrument. Final listings of articles were supplemented with hand searches of reference listings to ensure completeness. At least 2 reviewers independently completed each step of the review process: article selection, data extraction, and methodologic quality assessment of relevant articles using a validated rating scale. All discrepancies between raters were resolved by consensus.FindingsOf 9409 articles identified, 228 underwent full text review, and we identified 42 different instruments of delirium severity. Eleven of the 42 tools were multidomain, delirium-specific instruments providing a quantitative rating of delirium severity; these instruments underwent a methodologic quality review. Applying prespecified criteria related to frequency of use, methodologic quality, construct or predictive validity, and broad domain coverage, an expert panel used an iterative modified Delphi process to select 6 final high-quality instruments meeting these criteria: the Confusion Assessment Method-Severity Score, Confusional State Examination, Delirium-O-Meter, Delirium Observation Scale, Delirium Rating Scale, and Memorial Delirium Assessment Scale.Conclusions and relevanceThe 6 instruments identified may enable accurate measurement of delirium severity to improve clinical care for patients with this condition. This work may stimulate increased usage and head-to-head comparison of these instruments.

Project description:To develop a physiologic grading system for the severity of acute encephalopathy manifesting as delirium or coma, based on EEG, and to investigate its association with clinical outcomes.DesignThis prospective, single-center, observational cohort study was conducted from August 2015 to December 2016 and October 2018 to December 2019.SettingAcademic medical center, all inpatient wards.Patients/subjectsAdult inpatients undergoing a clinical EEG recording; excluded if deaf, severely aphasic, developmentally delayed, non-English speaking (if noncomatose), or if goals of care focused primarily on comfort measures. Four-hundred six subjects were assessed; two were excluded due to technical EEG difficulties.InterventionsNone.Measurements and main resultsA machine learning model, with visually coded EEG features as inputs, was developed to produce scores that correlate with behavioral assessments of delirium severity (Confusion Assessment Method-Severity [CAM-S] Long Form [LF] scores) or coma; evaluated using Spearman R correlation; area under the receiver operating characteristic curve (AUC); and calibration curves. Associations of Visual EEG Confusion Assessment Method Severity (VE-CAM-S) were measured for three outcomes: functional status at discharge (via Glasgow Outcome Score [GOS]), inhospital mortality, and 3-month mortality. Four-hundred four subjects were analyzed (mean [sd] age, 59.8 yr [17.6 yr]; 232 [57%] male; 320 [79%] White; 339 [84%] non-Hispanic); 132 (33%) without delirium or coma, 143 (35%) with delirium, and 129 (32%) with coma. VE-CAM-S scores correlated strongly with CAM-S scores (Spearman correlation 0.67 [0.62-0.73]; p < 0.001) and showed excellent discrimination between levels of delirium (CAM-S LF = 0 vs ≥ 4, AUC 0.85 [0.78-0.92], calibration slope of 1.04 [0.87-1.19] for CAM-S LF ≤ 4 vs ≥ 5). VE-CAM-S scores were strongly associated with important clinical outcomes including inhospital mortality (AUC 0.79 [0.72-0.84]), 3-month mortality (AUC 0.78 [0.71-0.83]), and GOS at discharge (0.76 [0.69-0.82]).ConclusionsVE-CAM-S is a physiologic grading scale for the severity of symptoms in the setting of delirium and coma, based on visually assessed electroencephalography features. VE-CAM-S scores are strongly associated with clinical outcomes.

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Dataset Information

Harmonization of delirium severity instruments: a comparison of the DRS-R-98, MDAS, and CAM-S using item response theory.

Background

Methods

Results

Conclusion

Publications

Harmonization of delirium severity instruments: a comparison of the DRS-R-98, MDAS, and CAM-S using item response theory.

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