Articles producció científica> Medicina i Cirurgia

Validation of the Delirium Diagnostic Tool-Provisional (DDT-Pro) in a skilled nursing facility and comparison to the 4 ‘A's test (4AT)

  • Identification data

    Identifier: imarina:9242158
    Authors:
    Sepulveda, EstebanBermudez, EsterGonzalez, DulceCotino, PaulaVinuelas, EvaPalma, JoseCiutat, MartaGrau, ImmaVilella, ElisabetTrzepacz, Paula TFranco, Jose G
    Abstract:
    Objective: To validate the Delirium Diagnostic Tool (DDT-Pro) in a SNF and compare its performance to the 4 A's Test (4AT) in real life conditions. Methods: Prospective cross-sectional study of 262 consecutively admitted adults to a SNF, independently assessed by psychiatrists using DSM-5 delirium criteria and by geriatricians using the DDT-Pro (0–9 points) and 4AT (0–12 points). Results: 141 (53.8%) participants had dementia and 79 (30.1%) had delirium. DDT-Pro and 4AT were moderately correlated (?0.59). Accuracies against DSM-5 diagnosis ranged from 80 to 85% and were comparable between tools regardless of dementia. Recommended delirium cutoff for the DDT-Pro (?6) had 77.2% sensitivity, 84% specificity, and NPV = 89.5% and 4AT (?4) had 54.4% sensitivity and 92.9% specificity, with lower specificity in the dementia subsample. DDT-Pro sensitivity increased (84.8%) at ?7cutoff. Sensitivity and specificity of all DDT-Pro and 2/4 4AT items displayed gradients along severity levels, but two dichotomously rated 4AT items had low positivity. The tools had low concordance (p < 0.05) for delirium positivity. Conclusions: DDT-Pro is valid to detect delirium in SNF population where simple, structured tools with high sensitivity are needed. DDT-Pro items assess the three core domains of delirium as a continuous measure and may have advantages over the 4AT. © 2021 Elsevier Inc.
  • Others:

    Author, as appears in the article.: Sepulveda, Esteban; Bermudez, Ester; Gonzalez, Dulce; Cotino, Paula; Vinuelas, Eva; Palma, Jose; Ciutat, Marta; Grau, Imma; Vilella, Elisabet; Trzepacz, Paula T; Franco, Jose G
    Department: Medicina i Cirurgia
    URV's Author/s: Bermúdez Gómez, Ester / FRANCO VÁSQUEZ, JOSÉ GABRIEL / González Ruiz, Dora Alejandra / GRAU JOAQUIN, INMACULADA CONCEPCIÓN / Sepulveda Ramos, Esteban / Vilella Cuadrada, Elisabet
    Keywords: Validation process Skilled nursing. Skilled nursing facilities Sensitivity and specificity Psychiatrist Psychiatric status rating scales. Prospective study Prospective studies Predictive value Nursing home Mental disease assessment Male Major clinical study Intermethod comparison Humans Human Geriatrician Geriatric assessment. Geriatric assessment Female Dsm-5 Disease severity Diagnostic tests comparison. Diagnostic test accuracy study Diagnostic accuracy Dementia Delirium diagnostic tool Delirium diagnosis Delirium Ddt Cross-sectional study Cross-sectional studies Controlled study Article Aged Adult 4 a test
    Abstract: Objective: To validate the Delirium Diagnostic Tool (DDT-Pro) in a SNF and compare its performance to the 4 A's Test (4AT) in real life conditions. Methods: Prospective cross-sectional study of 262 consecutively admitted adults to a SNF, independently assessed by psychiatrists using DSM-5 delirium criteria and by geriatricians using the DDT-Pro (0–9 points) and 4AT (0–12 points). Results: 141 (53.8%) participants had dementia and 79 (30.1%) had delirium. DDT-Pro and 4AT were moderately correlated (?0.59). Accuracies against DSM-5 diagnosis ranged from 80 to 85% and were comparable between tools regardless of dementia. Recommended delirium cutoff for the DDT-Pro (?6) had 77.2% sensitivity, 84% specificity, and NPV = 89.5% and 4AT (?4) had 54.4% sensitivity and 92.9% specificity, with lower specificity in the dementia subsample. DDT-Pro sensitivity increased (84.8%) at ?7cutoff. Sensitivity and specificity of all DDT-Pro and 2/4 4AT items displayed gradients along severity levels, but two dichotomously rated 4AT items had low positivity. The tools had low concordance (p < 0.05) for delirium positivity. Conclusions: DDT-Pro is valid to detect delirium in SNF population where simple, structured tools with high sensitivity are needed. DDT-Pro items assess the three core domains of delirium as a continuous measure and may have advantages over the 4AT. © 2021 Elsevier Inc.
    Thematic Areas: Saúde coletiva Psychiatry and mental health Psychiatry Psicología Medicina ii Medicina i Matemática / probabilidade e estatística Interdisciplinar Farmacia Ensino Enfermagem Direito Ciencias sociales Ciências biológicas ii Ciências biológicas i
    licence for use: https://creativecommons.org/licenses/by/3.0/es/
    Author's mail: esteban.sepulveda@urv.cat ester.bermudez@urv.cat elisabet.vilella@urv.cat doraalejandra.gonzalez@estudiants.urv.cat ester.bermudez@urv.cat
    Author identifier: 0000-0002-1887-5919
    Record's date: 2024-10-12
    Papper version: info:eu-repo/semantics/acceptedVersion
    Link to the original source: https://www.sciencedirect.com/science/article/abs/pii/S0163834321000463?via%3Dihub#!
    Licence document URL: https://repositori.urv.cat/ca/proteccio-de-dades/
    Papper original source: General Hospital Psychiatry. 70 116-123
    APA: Sepulveda, Esteban; Bermudez, Ester; Gonzalez, Dulce; Cotino, Paula; Vinuelas, Eva; Palma, Jose; Ciutat, Marta; Grau, Imma; Vilella, Elisabet; Trzepac (2021). Validation of the Delirium Diagnostic Tool-Provisional (DDT-Pro) in a skilled nursing facility and comparison to the 4 ‘A's test (4AT). General Hospital Psychiatry, 70(), 116-123. DOI: 10.1016/j.genhosppsych.2021.03.010
    Article's DOI: 10.1016/j.genhosppsych.2021.03.010
    Entity: Universitat Rovira i Virgili
    Journal publication year: 2021
    Publication Type: Journal Publications
  • Keywords:

    Psychiatry,Psychiatry and Mental Health
    Validation process
    Skilled nursing.
    Skilled nursing facilities
    Sensitivity and specificity
    Psychiatrist
    Psychiatric status rating scales.
    Prospective study
    Prospective studies
    Predictive value
    Nursing home
    Mental disease assessment
    Male
    Major clinical study
    Intermethod comparison
    Humans
    Human
    Geriatrician
    Geriatric assessment.
    Geriatric assessment
    Female
    Dsm-5
    Disease severity
    Diagnostic tests comparison.
    Diagnostic test accuracy study
    Diagnostic accuracy
    Dementia
    Delirium diagnostic tool
    Delirium diagnosis
    Delirium
    Ddt
    Cross-sectional study
    Cross-sectional studies
    Controlled study
    Article
    Aged
    Adult
    4 a test
    Saúde coletiva
    Psychiatry and mental health
    Psychiatry
    Psicología
    Medicina ii
    Medicina i
    Matemática / probabilidade e estatística
    Interdisciplinar
    Farmacia
    Ensino
    Enfermagem
    Direito
    Ciencias sociales
    Ciências biológicas ii
    Ciências biológicas i
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