Delirium Triage Screen/Brief Confusion Assessment Method in Adult Orthopaedic and Hematological Patients: A Validation Study.

Abstract

Delirium in the hospitalized orthopaedic patient is associated with numerous negative outcomes. Assessing for the presence of delirium using an accurate and reliable tool is essential. However, the number of validated screening tools is limited. The purpose of this study was to validate and test the reliability of the Delirium Triage Screening and brief Confusion Assessment Method (DTS/bCAM) to screen for delirium in non-intensive care (ICU) orthopaedic and hematological patients. This was a prospective, observational study. Seventy-six delirium assessments were completed on 19 orthopaedic patients and 10 hematological patients. The clinical nurse performed the DTS/bCAM during every 12-hour shift. Within 2 hours of this assessment, a research investigator performed both the DTS/bCAM and the Confusion Assessment Method (CAM). Each patient had a maximum of three assessments by a research investigator. Interrater reliability for the clinical nurse and the researcher was measured through comparison of positive and negative DTS/bCAM results. Validity was measured by comparing the matched DTS/bCAM and CAM results, both performed by the researcher. The DTS/bCAM and CAM results had 100% agreement. Two patients (7%) screened positive for delirium. Sensitivity of the DTS/bCAM was 100% (95% CI [15.8-100]) and specificity was 100% (95% CI [95.1, 100]). There was 86% agreement (43/50) between the clinical nurse and the researcher for the DTS/bCAM. In adult orthopaedic and hematological patients not receiving intensive care, the DTS/bCAM may be a valid, reliable, and rapid screening tool for delirium.