The Delirium Observation Screening Scale

Department of Nursing Science, University Medical Center Utrecht, The Netherlands.
Research and theory for nursing practice (Impact Factor: 0.61). 02/2003; 17(1):31-50. DOI: 10.1891/rtnp.
Source: PubMed

ABSTRACT The Delirium Observation Screening (DOS) scale, a 25-item scale, was developed to facilitate early recognition of delirium, according to the Diagnostic and Statistical Manual-IV criteria, based on nurses' observations during regular care. The scale was tested for content validity
by a group of seven experts in the field of delirium. Internal consistency, predictive validity, and concurrent and construct validity were tested in two prospective studies with high risk groups of patients: geriatric medicine patients and elderly hip fracture patients. Among the patients
admitted to a geriatric department (N = 82), 4 became delirious; among the elderly hip fracture patients (N = 92), 18 became delirious. The DOS scale was determined to be content valid and showed high internal consistency, α = 0.93 and α = 0.96. Predictive validity
against the Diagnostic and Statistical Manual-IV diagnosis of delirium made by a geriatrician was good in both studies. Correlations of the DOS scale with the Mini Mental State Examination (MMSE) were R
s -0.79 (p ≤ 0.001) in the hip fracture patients and
Rs -0.66 (p ≤ 0.001) in the geriatric medicine patients. Concurrent validity, as tested by comparison of the research nurse's ratings of the DOS scale and the Confusion Assessment Method (CAM), for the group of hip fracture patients was 0.63 (p ≤ 0.001). Construct
validity of the DOS was tested against the Informant Questionnaire of Cognitive Decline in Elderly (IQCODE), a preexisting psychiatric diagnosis and the Barthel Index. Correlation with the IQCODE was 0.74 (p ≤ 0.001) in the study with the hip fracture patients and 0.33 (p
≤ 0.05) in the study with the geriatric medicine patients. Correlation with the Barthel Index was -0.26 (p ≤ 0.05) in the geriatric medicine patients and -0.55 (p ≤ 0.001) in the hip fracture patients. The overall conclusion of these studies is that the DOS scale shows
satisfactory validity and reliability, to guide early recognition of delirium by nurses' observation.

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Available from: Marieke J Schuurmans, Aug 21, 2015
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    • "To determine the presence/not of delirium, the 13-item Delirium Observation Scale (DOS) (Schuurmans et al., 2003) was used. This is a delirium rating scale that is widely used in hospital settings in the Netherlands and has been rated by nurses to be more user-friendly than other well-known delirium rating scales (see, e.g., van Gemert and Schuurmans, 2007). "
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    ABSTRACT: The aim of this study was to examine early cognitive performance after a delirium in elderly general hospital patients. Patients were divided into a delirium (n = 47) and a control (n = 25) group. One week before discharge and after delirium had cleared in the first group, all patients completed a neuropsychological test battery (The Cambridge Cognitive Examination-Revised [CAMCOG-R]). Group differences in cognitive performance were analyzed adjusting for differences in baseline sociodemographic and clinical variables. Adjusting for group differences in baseline variables, the delirium group performed significantly worse than the control group on CAMCOG-R; its subdomains language, praxis, and executive functioning; and on Mini Mental State Examination derived from CAMCOG-R. The occurrence of delirium in hospital thus detrimentally affects early cognitive performance.
    The Journal of nervous and mental disease 09/2014; 202(10):732-737. DOI:10.1097/NMD.0000000000000182 · 1.81 Impact Factor
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    • "There is a wide range of scales available for delirium screening, including the Delirium Observation Screening Scale (DOS) [19] and the Confusion Assessment Method (CAM) [20], which are all based on assessments by medical professionals, often requiring a full psychiatric examination or multiple observations. The utility of these scales is limited by the requirement that raters have an accurate awareness of patient's baseline and recent mental status. "
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    ABSTRACT: Objectives Delirium is common in older patients admitted to hospital. Information obtained from patient's relatives or caregivers may contribute to improved detection. Our aim was to develop a caregiver based questionnaire, the Informant Assessment of Geriatric Delirium (I-AGeD), to assist in better recognition of delirium in elderly patients.MethodsA cross-sectional observational study using a scale construction patient cohort and two validation cohorts was conducted at geriatric departments of two teaching hospitals in the Netherlands. Delirium status, based on DSM-IV criteria, was assessed directly on admission by a geriatric resident and research coordinator and evaluated within the first 48 hours of admission. Questionnaire item sampling was based on discussions with an expertpanel. Caregivers filled out a 37-item questionnaire of which ten items were selected reflecting delirium symptoms, based on their discriminatory abilities, internal consistency and interitem correlations.ResultsA total of 88 patients with complete study protocols in the construction cohort were included. Average age was 86.4 (SD 8.5), and 31/88 patients had delirium on admission. Internal consistency of the 10-item I-AGeD was high (Cronbach's alpha = 0.85). At a cut-off score greater than 4 sensitivity was 77.4% and specificity 63.2%. In patients without dementia, sensitivity was 100% and specificity 65.2%. Validation occurred by means of two validation cohorts, one consisted of 59 patients and the other of 33 patients. Sensitivity and specificity in these samples ranged from 70.0–88.9% and 66.7%–100%.Conclusion The newly constructed caregiver based I-AGeD questionnaire is a valid screening instrument for delirium on admission to hospital in geriatric patients.
    European geriatric medicine 04/2013; 4(2):73–77. DOI:10.1016/j.eurger.2012.11.006 · 0.55 Impact Factor
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    • "At both sites , a multidisciplinary team was available , a geriatric environment was present ( walking circuit , living room ) , and nursing staff consisted of mainly registered nurses , most of whom were qualified clinical geriatric nurses ( 350 - hour programme ) . All patients admitted were eligible for partic - ipation unless they met one of the following exclusion criteria : being bedridden , inability to communicate in Dutch , the presence of delirium symptoms [ Delirium Observation Scale ( DOS ) ‡ 3 ; Schuurmans et al. 2003 ] or severe dementia ( CDR = 3 ; Hughes et al . 1982 ) , inability to hear or read or inability to sufficiently or not cooperate with neuropsycho - logical testing . "
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    ABSTRACT: Aims and objectives.  To examine the psychometric properties of the Nurses' Observation Scale for Cognitive Abilities. Background.  Nurses' Observation Scale for Cognitive Abilities is a behavioural rating scale comprising eight subscales that represent different cognitive domains. It is based on observations during contact between nurse and patient. Design.  Observational study. Methods.  A total of 50 patients from two geriatric wards in acute care hospitals participated in this study. Reliability was examined via internal consistency and inter-rater reliability. Construct validity of the Nurses' Observation Scale for Cognitive Abilities and its subscales were explored by means of convergent and divergent validity and post hoc analyses for group differences. Results.  Cronbach's αs of the total Nurses' Observation Scale for Cognitive Abilities and its subscales were 0·98 and 0·66-0·93, respectively. The item-total correlations were satisfactory (overall > 0·4). The intra-class coefficients were good (37 of 39 items > 0·4). The convergent validity of the Nurses' Observation Scale for Cognitive Abilities against cognitive ratings (MMSE, NOSGER) and severity of dementia (Clinical Dementia Rating) demonstrated satisfactory correlations (0·59-0·70, p < 0·01), except for IQCODE (0·30, p > 0·05). The divergent validity of the Nurses' Observation Scale for Cognitive Abilities against depressive symptoms was low (0·12, p > 0·05). The construct validity of the Nurses' Observation Scale for Cognitive Abilities subscales against 13 specific neuropsychological tests showed correlations varying from poor to fair (0·18-0·74; 10 of 13 correlations p < 0·05). Conclusions.  Validity and reliability of the total Nurses' Observation Scale for Cognitive Abilities are excellent. The correlations between the Nurses' Observation Scale for Cognitive Abilities subscales and standard neuropsychological tests were moderate. More conclusive results may be found if the Nurses' Observation Scale for Cognitive Abilities subscales were to be validated using more ecologically valid tests and in a patient population with less cognitive impairment. Relevance to clinical practice.  Use of the Nurses' Observation Scale for Cognitive Abilities yields standardised, reliable and valid information about patient's cognitive behaviour in daily practice. The Nurses' Observation Scale for Cognitive Abilities aids in tailoring nursing interventions to patients' specific cognitive needs. We advocate the implementation of the Nurses' Observation Scale for Cognitive Abilities both in research and at geriatric units in acute care hospitals.
    Journal of Clinical Nursing 11/2012; 21(21-22):3025-3036. DOI:10.1111/j.1365-2702.2012.04129.x · 1.23 Impact Factor
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