Repositori URV

Author, as appears in the article.: Sepulveda E; Franco JG; Trzepacz PT; Gaviria AM; Meagher DJ; Palma J; Viñuelas E; Grau I; Vilella E; de Pablo J

Department: Medicina i Cirurgia

URV's Author/s: FRANCO VÁSQUEZ, JOSÉ GABRIEL / Vilella Cuadrada, Elisabet

Keywords: Validity Subsyndromal delirium Spanish version Sensitivity and specificity Scale-revised-98 reliability Reliability Rating-scale revised-98 Population Motor subtypes International classification of diseases Informant questionnaire Elderly medical inpatients Discriminant analysis Diagnostic and statistical manual of mental disorders Dementia Delirium rating scale-revised-98 Delirium Cognitive decline Cluster analysis

Abstract: © 2016 The Author(s). Background: Information on validity and reliability of delirium criteria is necessary for clinicians, researchers, and further developments of DSM or ICD. We compare four DSM and ICD delirium diagnostic criteria versions, which were developed by consensus of experts, with a phenomenology-based natural diagnosis delineated using cluster analysis of delirium features in a sample with a high prevalence of dementia. We also measured inter-rater reliability of each system when applied by two evaluators from distinct disciplines. Methods: Cross-sectional analysis of 200 consecutive patients admitted to a skilled nursing facility, independently assessed within 24-48 h after admission with the Delirium Rating Scale-Revised-98 (DRS-R98) and for DSM-III-R, DSM-IV, DSM-5, and ICD-10 criteria for delirium. Cluster analysis (CA) delineated natural delirium and nondelirium reference groups using DRS-R98 items and then diagnostic systems' performance were evaluated against the CA-defined groups using logistic regression and crosstabs for discriminant analysis (sensitivity, specificity, percentage of subjects correctly classified by each diagnostic system and their individual criteria, and performance for each system when excluding each individual criterion are reported). Kappa Index (K) was used to report inter-rater reliability for delirium diagnostic systems and their individual criteria. Results: 117 (58.5 %) patients had preexisting dementia according to the Informant Questionnaire on Cognitive Decline in the Elderly. CA delineated 49 delirium subjects and 151 nondelirium. Against these CA groups, delirium diagnosis accuracy was highest using DSM-III-R (87.5 %) followed closely by DSM-IV (86.0 %), ICD-10 (85.5 %) and DSM-5 (84.5 %). ICD-10 had the highest specificity (96.0 %) but lowest sensitivity (53.1 %). DSM-III-R had the best sensitivity (81.6 %) and the best sensitivity-specificity balance. DSM-5 had the highest inter-rater reliability (K =0.73) while DSM-III-R criteria were the least reliable. Conclusions: Using our CA-defined, phenomenologically-based delirium designations as the reference standard, we found performance discordance among four diagnostic systems when tested in subjects where comorbid dementia was prevalent. The most complex diagnostic systems have higher accuracy and the newer DSM-5 have higher reliability. Our novel phenomenological approach to designing a delirium reference standard may be preferred to guide revisions of diagnostic systems in the future.

Thematic Areas: Saúde coletiva Psychiatry and mental health Psychiatry Psicología Nutrição Medicina iii Medicina ii Medicina i Interdisciplinar Geografía Engenharias i Enfermagem Educação física Ciências biológicas ii Ciências biológicas i Biotecnología Antropologia / arqueologia

licence for use: https://creativecommons.org/licenses/by/3.0/es/

ISSN: 1471244X

Author's mail: elisabet.vilella@urv.cat

Author identifier: 0000-0002-1887-5919

Record's date: 2024-09-07

Papper version: info:eu-repo/semantics/publishedVersion

Link to the original source: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0878-6

Licence document URL: https://repositori.urv.cat/ca/proteccio-de-dades/

Papper original source: Bmc Psychiatry. 16 (1):

APA: Sepulveda E; Franco JG; Trzepacz PT; Gaviria AM; Meagher DJ; Palma J; Viñuelas E; Grau I; Vilella E; de Pablo J (2016). Delirium diagnosis defined by cluster analysis of symptoms versus diagnosis by DSM and ICD criteria: Diagnostic accuracy study. Bmc Psychiatry, 16(1), -. DOI: 10.1186/s12888-016-0878-6

Article's DOI: 10.1186/s12888-016-0878-6

Entity: Universitat Rovira i Virgili

Journal publication year: 2016

Publication Type: Journal Publications