The Delirium Observation Screening Scale

Department of Nursing Science, University Medical Center Utrecht, The Netherlands.
Research and theory for nursing practice (Impact Factor: 0.36). 02/2003; 17(1):31-50. DOI: 10.1891/rtnp.
Source: PubMed


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
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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.
    Full-text · Article · Sep 2014 · The Journal of nervous and mental disease
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    • "The Confusion Assessment Method (CAM) will be used to diagnose delirium according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) delirium criteria during the study intervention period, and to ensure delirium is not present on study inclusion [27]. 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]. "
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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.
    Full-text · Article · Aug 2014 · BMC Geriatrics
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    • "All hip fracture patients were clustered on one nursing ward in order to increase the knowledge of the nursing staff and, thus improve the quality of care for the patient, with extra attention for care for elderly patients (early start of rehabilitation, adequate diet, pressure ulcer prevention). Additional attention was paid to delirium and its prevention, by applying the Delirium Observation Screening scale (DOS) by nurses on each shift [14,15]. "
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    ABSTRACT: Background Hip fractures frequently occur in older persons and severely decrease life expectancy and independence. Several care pathways have been developed to lower the risk of negative outcomes but most pathways are limited to only one aspect of care. The aim of this study was therefore to develop a comprehensive care pathway for older persons with a hip fracture and to conduct a preliminary analysis of its effect. Methods A comprehensive multidisciplinary care pathway for patients aged 60 years or older with a hip fracture was developed by a multidisciplinary team. The new care pathway was evaluated in a clinical trial with historical controls. The data of the intervention group were collected prospectively. The intervention group included all patients with a hip fracture who were admitted to University Medical Center Groningen between 1 July 2009 and 1 July 2011. The data of the control group were collected retrospectively. The control group comprised all patients with a hip fracture who were admitted between 1 January 2006 and 1 January 2008. The groups were compared with the independent sample t-test, the Mann–Whitney U-test or the Chi-squared test (Phi test). The effect of the intervention on fasting time and length of stay was adjusted by linear regression analysis for differences between the intervention and control group. Results The intervention group included 256 persons (women, 68%; mean age (SD), 78 (9) years) and the control group 145 persons (women, 72%; mean age (SD), 80 (10) years). Median preoperative fasting time and median length of hospital stay were significantly lower in the intervention group: 9 vs. 17 hours (p < 0.001), and 7 vs. 11 days (p < 0.001), respectively. A similar result was found after adjustment for age, gender, living condition and American Society of Anesthesiologists (ASA) classification. In-hospital mortality was also lower in the intervention group: 2% vs. 6% (p < 0.05). There were no statistically significant differences in other outcome measures. Conclusions The new comprehensive care pathway was associated with a significant decrease in preoperative fasting time and length of hospital stay.
    Full-text · Article · May 2014 · BMC Musculoskeletal Disorders
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