Takehiko Yamanashi1,2, Masaaki Iwata2, Kaitlyn J Crutchley1, Eleanor J Sullivan1, Johnny R Malicoat1, Zoe-Ella M Anderson1, Pedro S Marra1, Gloria Chang1, Koichi Kaneko2, Eri Shinozaki3, Sangil Lee4, Gen Shinozaki1,5,6,7,8. 1. Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. 2. Department of Neuropsychiatry, Tottori University Faculty of Medicine, Yonago, Tottori, Japan. 3. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. 4. Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. 5. Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. 6. Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. 7. Iowa Neuroscience Institute, Iowa City, Iowa, USA. 8. Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, Iowa, USA.
Abstract
BACKGROUND/ OBJECTIVES: Detecting delirium is important to identify patients with a high risk of poor outcomes. Although many different kinds of screening instruments for delirium exist, there is no solid consensus about which methods are the most effective. In addition, it is important to find the most useful tools in predicting outcomes such as mortality. DESIGN: Retrospective cohort study. SETTING: University of Iowa Hospitals and Clinics. PARTICIPANTS: A total of 1,125 adult inpatients (mean age = 67.7; median age = 69). MEASUREMENTS: Post hoc analyses were performed based on existing data from the Confusion Assessment Method for Intensive Care Unit (CAM-ICU), Delirium Rating Scale-Revised-98 (DRS), and the Delirium Observation Screening Scale (DOSS). Correlation among these scales and relationships between 365-day mortality and each scale were evaluated. RESULTS: A positive result on the CAM-ICU ("CAM-ICU positive") was associated with higher DRS and DOSS scores. A DRS score = 9/10 was the best cutoff to detect CAM-ICU positive, and DOSS = 2/3 was the best cutoff to detect CAM-ICU positive. CAM-ICU positive was associated with high 365-day mortality. DRS score = 9/10 and DOSS score = 0/1 were found to differentiate mortality risk the most significantly. Higher DRS and DOSS scores significantly coincided with a decrease in a patient's survival rate at 365 days. CONCLUSION: The best DRS and DOSS cutoff scores to differentiate 365-day mortality risk were lower than those commonly used to detect delirium in the literature. New cutoff scores for the DRS and DOSS might be useful in differentiating risk of mortality among hospital patients.
BACKGROUND/ OBJECTIVES: Detecting delirium is important to identify patients with a high risk of poor outcomes. Although many different kinds of screening instruments for delirium exist, there is no solid consensus about which methods are the most effective. In addition, it is important to find the most useful tools in predicting outcomes such as mortality. DESIGN: Retrospective cohort study. SETTING: University of Iowa Hospitals and Clinics. PARTICIPANTS: A total of 1,125 adult inpatients (mean age = 67.7; median age = 69). MEASUREMENTS: Post hoc analyses were performed based on existing data from the Confusion Assessment Method for Intensive Care Unit (CAM-ICU), Delirium Rating Scale-Revised-98 (DRS), and the Delirium Observation Screening Scale (DOSS). Correlation among these scales and relationships between 365-day mortality and each scale were evaluated. RESULTS: A positive result on the CAM-ICU ("CAM-ICU positive") was associated with higher DRS and DOSS scores. A DRS score = 9/10 was the best cutoff to detect CAM-ICU positive, and DOSS = 2/3 was the best cutoff to detect CAM-ICU positive. CAM-ICU positive was associated with high 365-day mortality. DRS score = 9/10 and DOSS score = 0/1 were found to differentiate mortality risk the most significantly. Higher DRS and DOSS scores significantly coincided with a decrease in a patient's survival rate at 365 days. CONCLUSION: The best DRS and DOSS cutoff scores to differentiate 365-day mortality risk were lower than those commonly used to detect delirium in the literature. New cutoff scores for the DRS and DOSS might be useful in differentiating risk of mortality among hospital patients.
Authors: Takehiko Yamanashi; Pedro S Marra; Kaitlyn J Crutchley; Nadia E Wahba; Johnny R Malicoat; Eleanor J Sullivan; Cade C Akers; Catherine A Nicholson; Felipe M Herrmann; Matthew D Karam; Nicolas O Noiseux; Koichi Kaneko; Eri Shinozaki; Masaaki Iwata; Hyunkeun Ryan Cho; Sangil Lee; Gen Shinozaki Journal: Sci Rep Date: 2021-07-09 Impact factor: 4.996