Benjamin K I Helfand1, Elke Detroyer2, Koen Milisen2, Dimitrios Adamis2, Eran D Metzger2, Edwin D Boudreaux2, Sharon K Inouye3, Richard N Jones2. 1. Department of Emergency Medicine (BKIH, EDB), University of Massachusetts Medical School, Worcester, MA; Department of Psychiatry and Human Behavior (BKIH, RNJ), Warren Alpert Medical School of Brown University, Providence, RI; Department of Neurology (BKIH, RNJ), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health and Primary Care (ED, KM) , Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Department of Geriatrics (ED, KM), University Hospitals Leuven, Leuven, Belgium; Cognitive Impairment Research Group, Sligo Mental Health Services; Sligo, Ireland and Centre for Interventions in Infection, Inflammation & Immunity, Graduate Entry Medical School (DA), University of Limerick, Limerick, Ireland; Department of Psychiatry (EDM), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Departments of Psychiatry, and Population and Quantitative Health Sciences (EDB), University of Massachusetts Medical School, Worcester, MA; Department of Medicine (SKI), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, Aging Brain Center (SKI, RNJ, EDM), Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA. Electronic address: Benjamin.helfand@umassmed.edu. 2. Department of Emergency Medicine (BKIH, EDB), University of Massachusetts Medical School, Worcester, MA; Department of Psychiatry and Human Behavior (BKIH, RNJ), Warren Alpert Medical School of Brown University, Providence, RI; Department of Neurology (BKIH, RNJ), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health and Primary Care (ED, KM) , Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Department of Geriatrics (ED, KM), University Hospitals Leuven, Leuven, Belgium; Cognitive Impairment Research Group, Sligo Mental Health Services; Sligo, Ireland and Centre for Interventions in Infection, Inflammation & Immunity, Graduate Entry Medical School (DA), University of Limerick, Limerick, Ireland; Department of Psychiatry (EDM), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Departments of Psychiatry, and Population and Quantitative Health Sciences (EDB), University of Massachusetts Medical School, Worcester, MA; Department of Medicine (SKI), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, Aging Brain Center (SKI, RNJ, EDM), Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA. 3. Department of Emergency Medicine (BKIH, EDB), University of Massachusetts Medical School, Worcester, MA; Department of Psychiatry and Human Behavior (BKIH, RNJ), Warren Alpert Medical School of Brown University, Providence, RI; Department of Neurology (BKIH, RNJ), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health and Primary Care (ED, KM) , Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Department of Geriatrics (ED, KM), University Hospitals Leuven, Leuven, Belgium; Cognitive Impairment Research Group, Sligo Mental Health Services; Sligo, Ireland and Centre for Interventions in Infection, Inflammation & Immunity, Graduate Entry Medical School (DA), University of Limerick, Limerick, Ireland; Department of Psychiatry (EDM), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Departments of Psychiatry, and Population and Quantitative Health Sciences (EDB), University of Massachusetts Medical School, Worcester, MA; Department of Medicine (SKI), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, Aging Brain Center (SKI, RNJ, EDM), Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA. Electronic address: AgingBrainCenter@hsl.harvard.edu.
Abstract
OBJECTIVES: Over 30 instruments are in current, active use for delirium identification. In a recent systematic review, we recommended 4 commonly used and well-validated instruments for clinical and research use. The goal of this study is to harmonize the four instruments on the same metric using modern methods in psychometrics. DESIGN: Secondary data analysis from 3 studies, and a simulation study based on the observed data. SETTING: Hospitalized (non-ICU) adults over 65 years old in the United States, Ireland, and Belgium. PARTICIPANTS: The total sample comprised 600 participants, contributing 1,623 assessments. MEASUREMENTS: Confusion Assessment Method (long-form and short-form), Delirium Observation Screening Scale, Delirium Rating Scale-Revised-98 (DRS-R-98) (total and severity scores), and Memorial Delirium Assessment Scale. RESULTS: Using item response theory, we linked scores across instruments, placing all four instruments and their separate scorings on the same metric (the propensity to delirium). Kappa statistics comparing agreement in delirium identification among the instruments ranged from 0.37 to 0.75, with the highest agreement between the DRS-R-98 total score and MDAS. After linking scores, we created a harmonized item bank, called the Delirium Item Bank (DEL-IB), consisting of 50 items. The DEL-IB allowed us to create six crosswalks, to allow scores to be translated across instruments. CONCLUSIONS: With our results, individual instrument scores can be directly compared to aid in clinical decision-making, and quantitatively combined in meta-analyses.
OBJECTIVES: Over 30 instruments are in current, active use for delirium identification. In a recent systematic review, we recommended 4 commonly used and well-validated instruments for clinical and research use. The goal of this study is to harmonize the four instruments on the same metric using modern methods in psychometrics. DESIGN: Secondary data analysis from 3 studies, and a simulation study based on the observed data. SETTING: Hospitalized (non-ICU) adults over 65 years old in the United States, Ireland, and Belgium. PARTICIPANTS: The total sample comprised 600 participants, contributing 1,623 assessments. MEASUREMENTS: Confusion Assessment Method (long-form and short-form), Delirium Observation Screening Scale, Delirium Rating Scale-Revised-98 (DRS-R-98) (total and severity scores), and Memorial Delirium Assessment Scale. RESULTS: Using item response theory, we linked scores across instruments, placing all four instruments and their separate scorings on the same metric (the propensity to delirium). Kappa statistics comparing agreement in delirium identification among the instruments ranged from 0.37 to 0.75, with the highest agreement between the DRS-R-98 total score and MDAS. After linking scores, we created a harmonized item bank, called the Delirium Item Bank (DEL-IB), consisting of 50 items. The DEL-IB allowed us to create six crosswalks, to allow scores to be translated across instruments. CONCLUSIONS: With our results, individual instrument scores can be directly compared to aid in clinical decision-making, and quantitatively combined in meta-analyses.
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