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Detecting delirium in elderly medical emergency patients: validation and subsequent modification of the German Nursing Delirium Screening Scale

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Abstract

Detecting delirium in elderly emergency patients is critical to their outcome. The Nursing Delirium Screening Scale (Nu-DESC) is a short, feasible instrument that allows nurses to systematically screen for delirium. This is the first study to validate the Nu-DESC in a German emergency department (ED). The Nu-DESC was implemented in a high-volume, interdisciplinary German ED. A consecutively recruited sample of medical patients aged ≥ 70 years was screened by assigned nurses who performed the Nu-DESC as part of their daily work routine. The results were compared to a criterion standard diagnosis of delirium. According to the criterion standard diagnosis, delirium was present in 47 (14.9%) out of the 315 patients enrolled. The Nu-DESC shows a good specificity level of 91.0% (95% CI 87.0–94.2), but a moderate sensitivity level of 66.0% (95% CI 50.7–79.1). Positive and negative likelihood ratios are 7.37 (95% CI 4.77–11.36) and 0.37 (95% CI 0.25–0.56), respectively. In an exploratory analysis, we find that operationalizing the Nu-DESC item “disorientation” by specifically asking patients to state the day of the week and the name of the hospital unit would raise Nu-DESC sensitivity to 77.8%, with a specificity of 84.6% (positive and negative likelihood ratio of 5.05 and 0.26, respectively). The Nu-DESC shows good specificity but moderate sensitivity when performed by nurses during their daily work in a German ED. We have developed a modified Nu-DESC version, resulting in markedly enhanced sensitivity while maintaining a satisfactory level of specificity.

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Acknowledgements

We thank all the Emergency Department nurses at the University Hospital of Freiburg who performed the Nu-DESC. We also thank Susanne Weber, MSc, (Institute of Medical Biometry and Statistics, Medical Faculty and Medical Center, University of Freiburg) for advice on the data analysis.

Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

Author information

Author notes

  1. Jochen Brich and Verena Baten contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology and Neuroscience, Medical Center, University of Freiburg, Freiburg, Germany

    Jochen Brich & Verena Baten

  2. Department of Emergency Medicine, University Hospital of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Verena Baten, Judith Wußmann & Hans-Jörg Busch

  3. Center of Geriatrics and Gerontology Freiburg, Medical Center, University of Freiburg, Freiburg, Germany

    Miriam Heupel-Reuter

  4. Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Evgeniy Perlov & Stefan Klöppel

  5. Clinic for Psychiatry Luzern, St. Urban, Switzerland

    Evgeniy Perlov

  6. Center for Geriatric Medicine and Gerontology, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Stefan Klöppel

  7. University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland

    Stefan Klöppel

Authors
  1. Jochen Brich
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  2. Verena Baten
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  3. Judith Wußmann
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  4. Miriam Heupel-Reuter
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  7. Hans-Jörg Busch
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Corresponding author

Correspondence to Jochen Brich.

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Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human and/or animal participants

The study was approved by the Local Ethics Committee (No. 72/16). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

If possible, oral informed consent was obtained directly from the patient or an authorized proxy. According to our local ethics committee written or verbal consent from the patients was not required as this was an evaluation-based study aiming for permanent implementation of the Nu-DESC for delirium screening in the ED. In order to ensure the best treatment for all patients, EPs were informed about the criterion standard diagnosis subsequent to the completion of all tests.

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Brich, J., Baten, V., Wußmann, J. et al. Detecting delirium in elderly medical emergency patients: validation and subsequent modification of the German Nursing Delirium Screening Scale. Intern Emerg Med 14, 767–776 (2019). https://doi.org/10.1007/s11739-018-1989-5

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  • DOI: https://doi.org/10.1007/s11739-018-1989-5

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