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The delirium index, a measure of the severity of delirium: new findings on reliability, validity, and responsiveness.
J Am Geriatr Soc. 2004 Oct; 52(10):1744-9.JA

Abstract

OBJECTIVES

To assess the reliability, validity, and responsiveness of an instrument for measuring the severity of delirium, the Delirium Index (DI).

DESIGN

Prospective cohort study, with repeated patient assessments at multiple points in the hospital, at 8 weeks after discharge, and at 6 and 12 months after admission.

SETTING

The medical services of a primary acute-care hospital.

PARTICIPANTS

Medical admissions aged 65 and older: 165 with delirium and dementia, 57 with delirium only, 55 with dementia only, and 41 with neither.

MEASUREMENTS

Severity of delirium symptoms was measured using the DI. Delirium was diagnosed using the Confusion Assessment Method. Other measures included the Mini-Mental State Examination, Informant Questionnaire on Cognitive Decline in the Elderly, Barthel Index (BI), premorbid instrumental activities of daily living, Charlson Comorbidity Index, Clinical Severity of Illness scale (CSI), and the Acute Physiology Score (APS).

RESULTS

The intraclass correlation coefficient of interrater reliability was 0.98. Two measures of fluctuation were significantly higher in patients with delirium than in those without delirium. At baseline, the DI was correlated with the BI, APS, and CSI in delirious patients with (correlation coefficient (r)=-0.43, 0.17, and 0.36, respectively) or without (r=-0.44, 0.39, 0.22, respectively) dementia. At 8 weeks, in delirious patients with and without dementia, internal responsiveness as measured by effect sizes was -0.60 and -0.74, respectively, and the standardized response mean for both groups was -0.64. Low to good levels of external responsiveness were found.

CONCLUSION

The DI appears to be a reliable, valid, and responsive measure of the severity of delirium, in patients with delirium, with or without dementia.

Authors+Show Affiliations

Department of Clinical Epidemiology and Community Studies, St Mary's Hospital, Montreal, Quebec, Canada. jane.mccusker@mcgill.caNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15450055

Citation

McCusker, Jane, et al. "The Delirium Index, a Measure of the Severity of Delirium: New Findings On Reliability, Validity, and Responsiveness." Journal of the American Geriatrics Society, vol. 52, no. 10, 2004, pp. 1744-9.
McCusker J, Cole MG, Dendukuri N, et al. The delirium index, a measure of the severity of delirium: new findings on reliability, validity, and responsiveness. J Am Geriatr Soc. 2004;52(10):1744-9.
McCusker, J., Cole, M. G., Dendukuri, N., & Belzile, E. (2004). The delirium index, a measure of the severity of delirium: new findings on reliability, validity, and responsiveness. Journal of the American Geriatrics Society, 52(10), 1744-9.
McCusker J, et al. The Delirium Index, a Measure of the Severity of Delirium: New Findings On Reliability, Validity, and Responsiveness. J Am Geriatr Soc. 2004;52(10):1744-9. PubMed PMID: 15450055.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The delirium index, a measure of the severity of delirium: new findings on reliability, validity, and responsiveness. AU - McCusker,Jane, AU - Cole,Martin G, AU - Dendukuri,Nandini, AU - Belzile,Eric, PY - 2004/9/29/pubmed PY - 2004/11/4/medline PY - 2004/9/29/entrez SP - 1744 EP - 9 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 52 IS - 10 N2 - OBJECTIVES: To assess the reliability, validity, and responsiveness of an instrument for measuring the severity of delirium, the Delirium Index (DI). DESIGN: Prospective cohort study, with repeated patient assessments at multiple points in the hospital, at 8 weeks after discharge, and at 6 and 12 months after admission. SETTING: The medical services of a primary acute-care hospital. PARTICIPANTS: Medical admissions aged 65 and older: 165 with delirium and dementia, 57 with delirium only, 55 with dementia only, and 41 with neither. MEASUREMENTS: Severity of delirium symptoms was measured using the DI. Delirium was diagnosed using the Confusion Assessment Method. Other measures included the Mini-Mental State Examination, Informant Questionnaire on Cognitive Decline in the Elderly, Barthel Index (BI), premorbid instrumental activities of daily living, Charlson Comorbidity Index, Clinical Severity of Illness scale (CSI), and the Acute Physiology Score (APS). RESULTS: The intraclass correlation coefficient of interrater reliability was 0.98. Two measures of fluctuation were significantly higher in patients with delirium than in those without delirium. At baseline, the DI was correlated with the BI, APS, and CSI in delirious patients with (correlation coefficient (r)=-0.43, 0.17, and 0.36, respectively) or without (r=-0.44, 0.39, 0.22, respectively) dementia. At 8 weeks, in delirious patients with and without dementia, internal responsiveness as measured by effect sizes was -0.60 and -0.74, respectively, and the standardized response mean for both groups was -0.64. Low to good levels of external responsiveness were found. CONCLUSION: The DI appears to be a reliable, valid, and responsive measure of the severity of delirium, in patients with delirium, with or without dementia. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/15450055/The_delirium_index_a_measure_of_the_severity_of_delirium:_new_findings_on_reliability_validity_and_responsiveness_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=2004&volume=52&issue=10&spage=1744 DB - PRIME DP - Unbound Medicine ER -