Validation of the Delirium Rating Scale-revised-98: Comparison with the Delirium Rating Scale and the Cognitive Test for Delirium

University of Mississippi Medical Center and the Sonny Montogomery Veterans Affairs Center, Jackson, USA.
Journal of Neuropsychiatry (Impact Factor: 2.82). 02/2001; 13(2):229-42.
Source: PubMed


The DRS-R-98, a 16-item clinician-rated scale with 13 severity items and 3 diagnostic items, was validated against the Cognitive Test for Delirium (CTD), Clinical Global Impression scale (CGI), and Delirium Rating Scale (DRS) among five diagnostic groups (N=68): delirium, dementia, depression, schizophrenia, and other. Mean and median DRS-R-98 scores significantly (P<0.001) distinguished delirium from each other group. DRS-R-98 total scores correlated highly with DRS, CTD, and CGI scores. Interrater reliability and internal consistency were very high. Cutoff scores for delirium are recommended based on ROC analyses (sensitivity and specificity ranges: total, 91%-100% and 85%-100%; severity, 86%-100% and 77%-93%, respectively, depending on the cutoffs or comparison groups chosen). The DRS-R-98 is a valid measure of delirium severity over a broad range of symptoms and is a useful diagnostic and assessment tool. The DRS-R-98 is ideal for longitudinal studies.

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Available from: Paula T Trzepacz,
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    • "Different methods, criteria, and rating scales were used in the study of delirium subtypes. Most researchers have used the Delirium Rating Scale (DRS) [18], DRS-R-98 [19], Confusion Assessment Method (CAM) [20], and CAM-ICU [21] for delirium diagnosis, while for subtyping the most widely used scale was the Ritchmond Agitation-Sedation Scale (RASS) [22]. Results are presented in Tables 1–7. "
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    ABSTRACT: Delirium is a complex neuropsychiatric syndrome which is common in all medical settings. It often goes unrecognized due to difficulties in the detection of its hypoactive variant. This review aims to provide an up-to-date account on recent research on hypoactive delirium (HD). Thirty-eight studies, which were conducted in various clinical settings, including the Intensive Care Unit (ICU), were included in this review. Those studies involved recent research that has been published during the last 6 years. Prevalence of HD was found to vary considerably among different settings. HD seems to be more common in critically ill patients and less common in patients examined by consultation-liaison psychiatric services and in mixed patient populations. The presence of HD in ICU patients was associated with higher short- and long-term mortality and other adverse outcomes, but no such association was reported in other settings. Research on other possible associations of HD with clinical variables and on symptom presentation yielded inconclusive results, although there is some evidence for a possible association of HD with benzodiazepine use. There are several methodological issues that need to be addressed by future research. Future studies should examine HD in the primary care setting; treatment interventions should also be the objective of future research.
    Behavioural neurology 09/2015; 2015(2):416792. DOI:10.1155/2015/416792
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    • "Algorithm based on DSM-III-R was used to classify patients as either positive or negative for delirium. Delirium Rating Scale-Revised-98 (DRS-R98) (Trzepacz et al., 2001) was used in its Colombian version (Franco et al., 2007) to diagnose delirium (Total scale, 16 items, range 0–46 points) and quantify severity of 13 delirium characteristics on a scale from 0 to 3 each (Severity scale). We used a cutoff for delirium diagnosis Z12 (from the 10 to 14 cutoff range recommended for this version). "
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    ABSTRACT: Because hypoactive delirium is especially under-recognized, we analysed which Mini-Mental State Examination (MMSE) items predicted incident delirium and its hypoactive motor presentation. Over a 1-year period, older medical inpatients (n=291) were consecutively screened on admission with the Confusion Assessment Method-Spanish (CAM-S) to exclude prevalent delirium. Nondelirious patients were evaluated the same day with the MMSE, followed by daily ratings with the CAM-S. Those who became CAM-S positive were rated using the Delirium Rating Scale–Revised-98 to assess severity and motor subtype. Disorientation to time (OR 4.4, 95%CI 1.7–11.1) and place (OR 3.8, 95%CI 1.7–8.2) at admission were risk factors for delirium at follow-up and together correctly classified 88.3% of subjects as to delirium status. Disorientation to time and place, and visuoconstructional impairment were each associated with either hypoactive or mixed subtype (p<0.05 χ2 test). Simple bedside evaluation of cognitive function in nondelirious patients revealed deficits that detected patients at risk for developing incident delirium at follow-up (especially hypoactive or mixed). We recommend patients with orientation deficits be monitored closely for emergence of delirium. A separate evaluation for possible dementia or other causes of cognitive impairment at admission should be considered too.
    Psychiatry Research 09/2014; in press. DOI:10.1016/j.psychres.2014.09.003
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    • "Nurses register the Delirium Observation Screening (DOS) scale three times a day (once every day, evening and night shift) during the intervention period to evaluate delirium symptoms [28,29]. Once delirium is established, one of the observers will perform the DRS-R-98 once-daily to assess delirium severity and duration [30]. An ECG is performed at baseline, after two and six treatment dosages, and at the end of the intervention period to register QTc intervals. "
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    ABSTRACT: Background: Delirium is associated with substantial morbidity and mortality rates in elderly hospitalised patients, and a growing problem due to increase in life expectancy. Implementation of standardised non-pharmacological delirium prevention strategies is challenging and adherence remains low. Pharmacological delirium prevention with haloperidol, currently the drug of choice for delirium, seems promising. However, the generalisability of randomised controlled trial results is questionable since studies have only been performed in selected postoperative hip-surgery and intensive care unit patient populations. We therefore present the design of the multicenter, randomised, double-blind, placebo-controlled clinical trial on early pharmacological intervention to prevent delirium: haloperidol prophylaxis in older emergency department patients (The HARPOON study). Methods/design: In six Dutch hospitals, at-risk patients aged 70 years or older acutely admitted through the emergency department for general medicine and surgical specialties are randomised (n = 390) for treatment with prophylactic haloperidol 1 mg or placebo twice daily for a maximum of seven consecutive days. Primary outcome measure is the incidence of in-hospital delirium within seven days of start of the study intervention, diagnosed with the Confusion Assessment Method, and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for delirium. Secondary outcome measures include delirium severity and duration assessed with the Delirium Rating Scale Revised 98; number of delirium-free days; adverse events; hospital length-of-stay; all-cause mortality; new institutionalisation; (Instrumental) Activities of Daily Living assessed with the Katz Index of ADL, and Lawton IADL scale; cognitive function assessed with the Six-item Cognitive Impairment Test, and the Dutch short form Informant Questionnaire on Cognitive Decline in the Elderly. Patients will be contacted by telephone three and six months post-discharge to collect data on cognitive- and physical function, home residency, all-cause hospital admissions, and all-cause mortality. Discussion: The HARPOON study will provide relevant information on the efficacy and safety of prophylactic haloperidol treatment for in-hospital delirium and its effects on relevant clinical outcomes in elderly at-risk medical and surgical patients. Trial registration: EudraCT Number: 201100476215; Identifier: NCT01530308; Dutch Clinical Trial Registry: NTR3207.
    BMC Geriatrics 08/2014; 14(1):96. DOI:10.1186/1471-2318-14-96
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