Delirium Observation Scale Research Articles

Standardised Frailty Indicator as Predictor for Postoperative Delirium after Vascular Surgery: A Prospective Cohort Study

Objectives To determine whether the Groningen Frailty Indicator (GFI) has a positive predictive value for postoperative delirium (POD) after vascular surgery. Methods Between March and August 2010, 142 consecutive vascular surgery patients were prospectively evaluated. Preoperatively, the GFI was obtained and postoperatively patients were screened with the Delirium Observation Scale (DOS). Patients with a DOS-score ≥3 points were assessed by a geriatrician. Delirium was defined by the DSM-IV-TR criteria. Primary outcome variable was the incidence of POD. Secondary outcome variables were any surgical complication and hospital length of stay (HLOS) (>7 days). Results Ten patients (7%) developed POD. The highest incidence of POD was found after aortic surgery (17%) and amputation procedures (40%). Increased comorbidities ( p = 0.006), GFI score ( p = 0.03), renal insufficiency ( p = 0.04), elevated C-reactive protein ( p = 0.008), high American Society of Anaesthesiologists score ( p = 0.05), a DOS-score of ≥3 points ( p = 0.001), post-operative intensive care unit admittance ( p = 0.01) and HLOS ≥7 days ( p = 0.005) were risk factors for POD. The GFI score was not associated with a prolonged HLOS. A mean number of 2 ± 1 (range 0–5) complications were registered. The receiver operator characteristics (ROC) area under the curve for the GFI was 0.70. Conclusions The GFI can be helpful in the early identification of POD after vascular surgery in a select group of high-risk patients.

Delirium after Emergency/Elective Open and Endovascular Aortoiliac Surgery at a Surgical Ward with a High-standard Delirium Care Protocol

Delirium is a common problem in elderly patients undergoing surgery. Standard delirium care is not available at all surgical wards. We determined the incidence, risk factors, and outcomes of postoperative delirium among patients undergoing elective/emergency aortoiliac surgery at a surgical ward with high-standard delirium care. A prospective descriptive survey in 107 patients was conducted. High-standard delirium care was given to patients above age 65, consisting of an extended focus on risk factors and intensive screening. The Delirium Observation Scale was used as a screening instrument for delirium. Patients were classified as having delirium if they met the DSM-IV criteria. The overall incidence of delirium was 23%. The incidence was 14% after elective surgery. Delirium occurred in 59% after emergency surgery and more often after open than after endovascular aneurysm repair (p < .01). Delirium was associated with age (p < .01) and emergency surgery (p = .01) and is an important and frequent complication after aortoiliac surgery.

Delirium after Abdominal Surgery at a Surgical Ward with a High Standard of Delirium Care: Incidence, Risk Factors and Outcomes

Background: Although delirium is a common problem in elderly patients undergoing surgery, standard delirium care is not available in all wards. The object of this study was to determine the incidence, risk factors and outcomes of postoperative delirium among patients aged 65 and above undergoing elective abdominal surgery at a surgical ward with a high standard delirium care. Methods: Prospective descriptive survey in 71 patients. The Delirium Observation Scale was used to screen for delirium. Patients were classified as having a delirium if they met the DSM IV-criteria. Delirious and nondelirious patients were compared and associated risk factors were calculated using logistic regression analyses. Results: Incidence of postoperative delirium was 24%. Univariate analysis showed that age above 74 years, CST score, ASA score, length of ICU stay, length of hospital stay and number of complications were significant risk factors for delirium. Older age, however, was the only significant risk factor in multivariate analysis (OR 1.16; 95% CI 1.00–1.35; p = 0.05). Lastly, mortality was significantly higher in the delirium group (29.4 vs. 3.7%; p = 0.001). Conclusion: At a surgical ward with high standard delirium care, the incidence of delirium was 24% and mortality was higher in delirious patients undergoing elective abdominal surgery.

Delirium-O-Meter: a nurses' rating scale for monitoring delirium severity in geriatric patients

Delirium is a common psychiatric disorder in general hospital elderly patients. Several delirium screening tests exist. Few nurse based delirium severity measures are available. The aim of this study was to evaluate the Delirium-O-Meter, a new nurses' behavioural rating scale that is an efficient and sensitive measure of delirium severity. Analysis of cross sectional and repeated assessments data. Participants were 92 elderly general hospital patients; 56 with delirium, 24 with dementia or other cognitive disturbances (no delirium) and 12 with other psychiatric disorders or no mental disorder. Measures were the Delirium-O-Meter (DOM), Delirium Rating Scale-Revised version (DRS-R-98), Delirium Observation Scale (DOS), Behavioural observation scale for geriatric inpatients (GIP) and Mini Mental State Examination (MMSE). The majority of DOM items show a (near-) normal score distribution. Reliability of the DOM was high; Cronbach's alpha values ranged from 0.87-0.92; Intra Class Correlation (ICC) range was 0.84-0.91 for total scores and 0.40-0.97 for item scores. Factor analysis produced a 'Cognitive/Motivational' factor explaining almost half of variance and a smaller 'Psychotic/Behavioural' factor. The two-factor model results support the conceptual distinction between hyperactive and hypoactive delirium. DOM observations differentiated delirium from non delirium patients. DOM total scores were highly related to the DRS-R-98, DOS, MMSE and GIP apathy and cognitive sub scales, but less so to the GIP affective disturbances subscale, indicating convergent and divergent validity. Temporal difference scores calculated for DRS-R-98 and DOM assessments on subsequent days were also highly related (rho = 0.80-0.95). The newly constructed DOM is a brief and valid nurses' behavioural rating scale that can be useful for measuring different aspects of delirium and for efficiently monitoring delirium severity in elderly patients.