Delirium detection tools show varying completion rates and positive score rates when used at scale in routine care: A systematic review

Rose Penfold, Charlotte Squires, Alisa Angus, Susan Deborah Shenkin, Temi Ibitoye, Zoe Tieges, Karin J. Neufeld, Thiago J. Avelino-Silva, Daniel Davis, Atul Anand, Andrew Duckworth, Bruce Guthrie, Alasdair M J MacLullich

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Multiple short delirium detection tools have been validated in research studies and implemented in routine care, but there has been little study of these tools in real-world conditions. This systematic review synthesized literature reporting completion rates and/or delirium positive score rates of detection tools in large clinical populations in general hospital settings.

PROSPERO (CRD42022385166).
Medline, Embase, PsycINFO, CINAHL, and gray literature were searched from
1980 to December 31, 2022. Included studies or audit reports used a validated
delirium detection tool performed directly with the patient as part of routine
care in large clinical populations (n ≥ 1000) within a general acute hospital
setting. Narrative synthesis was performed.

Twenty-two research studies and four audit reports were included.
Tools used alone or in combination were the Confusion Assessment Method
(CAM), 4 ‘A's Test (4AT), Delirium Observation Screening Scale (DOSS), Brief
CAM (bCAM), Nursing Delirium Screening Scale (NuDESC), and Intensive
Care Delirium Screening Checklist (ICDSC). Populations and settings varied
and tools were used at different stages and frequencies in the patient journey,
including on admission only; inpatient, daily or more frequently; on admission
and as inpatient; inpatient post-operatively. Tool completion rates ranged from
19% to 100%. Admission positive score rates ranged from: CAM 8%–51%; 4AT
13%–20%. Inpatient positive score rates ranged from: CAM 2%–20%, DOSS 6%–42%, and NuDESC 5–13%. Postoperative positive score rates were 21% and
28% (4AT). All but two studies had moderate–high risk of bias.

This systematic review of delirium detection tool implementation in large acute patient populations found clinically important variability in
tool completion rates, and in delirium positive score rates relative to expected
delirium prevalence. This study highlights a need for greater reporting and
analysis of relevant healthcare systems data. This is vital to advance understanding of effective delirium detection in routine care
Original languageEnglish
JournalJournal of the American Geriatrics Society
Early online date19 Jan 2024
Publication statusE-pub ahead of print - 19 Jan 2024

Keywords / Materials (for Non-textual outputs)

  • delirium
  • detection
  • geriatric assessment
  • hospitals
  • older people
  • routine data
  • systematic review


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