Autor según el artículo: José G. Franco; Esteban Sepulveda; Paula T. Trzepacz; Ana M. Gaviria; David J. Meagher; José Palma; Eva Viñuelas; Imma Grau; Elisabet Vilella; Joan de Pablo
Departamento: Medicina i Cirurgia Psicologia
Autor/es de la URV: FRANCO VÁSQUEZ, JOSÉ GABRIEL; Esteban Sepulveda; Paula T. Trzepacz; Ana M. Gaviria; David J. Meagher; José Palma; Eva Viñuelas; GRAU JOAQUIN, INMACULADA CONCEPCIÓN; Elisabet Vilella; Joan de Pablo
Palabras clave: Delirium Reliability
Resumen: 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.
Grupo de investigación: Grup d'Investigació en Psiquiatria
Áreas temáticas: Psicologia Psicología Psychology
Acceso a la licencia de uso: https://creativecommons.org/licenses/by/3.0/es/
ISSN: 1471-244X
Identificador del autor: 0000-0001-9255-8084; n/a; n/a; n/a; n/a; n/a; n/a; n/a; n/a; n/a
Fecha de alta del registro: 2016-06-09
Volumen de revista: 16
Versión del articulo depositado: info:eu-repo/semantics/publishedVersion
URL Documento de licencia: https://repositori.urv.cat/ca/proteccio-de-dades/
Entidad: Universitat Rovira i Virgili
Año de publicación de la revista: 2016
Página inicial: Article number 167
Tipo de publicación: Article Artículo Article
Repositori URV