Concordance between DSM-IV and DSM-5 criteria for delirium diagnosis in a pooled database of 768 prospectively evaluated patients using the delirium rating scale-revised-98

BMC Medicine

Paula T Trzepacz^1,14  Jos De Jonghe^1,11  Sophia E De Rooij^1,12  Barbara C Van Munster⁸  Barbara Kamholz^1,13  Colum Dunne⁶  Walter Cullen⁶  Faiza Jabbar^1,18  Sandeep Grover^1,16  Niamh O’Regan²  Suzanne Timmons²  Wolfgang Hasemann⁴  Christine Thomas^1,17  Stefan Kreisel⁹  Andrew Teodorczuk^1,15  Daniel Davis^2,21  Giuseppe Bellelli⁷  Maeve Leonard¹  Karin Neufeld^1,10  James L Rudolph^2,20  Alasdair J Maclullich⁵  Dimitrios Adamis⁶  Wes Ely³  Sharon K Inouye^1,19  Alessandro Morandi⁷  David J Meagher¹ 

[1] Department of Psychiatry, University Hospital Limerick, Limerick, Ireland;Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland;Tennessee Valley VA Geriatric Research Education Clinical Center (GRECC), Nashville, TN, USA;Practice Development in Nursing, University Hospital Basel, Basel, Switzerland;Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland, UK;Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland;Geriatric Research Group, Brescia, Italy;Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands;Department of Psychiatry and Psychotherapy, Bethel EvangelischesKrankenhaus, Bielefeld, Germany;Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA;Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands;Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands;Mental Health Services, San Francisco VA Medical Center, San Francisco, CA, USA;Indiana University School of Medicine, Indianapolis, IN, USA;Institute for Ageing and Health, Campus for Vitality, Newcastle University, Newcastle upon Tyne, UK;Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India;Department of Psychiatry and Psychotherapy of the Aged, Centre of Mental Health, Klinikum Stuttgart, Germany;Psychiatry for Later Life Service, University College Hospital, Galway, Ireland;Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

关键词: Dementia;    Neurocognitive disorders;    Cognition;    Diagnosis;    Classification;    Delirium;   

Others  :  1121423
DOI  :  10.1186/s12916-014-0164-8

 received in 2014-06-06, accepted in 2014-08-29,  发布年份 2014

【 摘 要 】

Background

The Diagnostic and Statistical Manual fifth edition (DSM-5) provides new criteria for delirium diagnosis. We examined delirium diagnosis using these new criteria compared with the Diagnostic and Statistical Manual fourth edition (DSM-IV) in a large dataset of patients assessed for delirium and related presentations.

Methods

Patient data (n = 768) from six prospectively collected cohorts, clinically assessed using DSM-IV and the Delirium Rating Scale-Revised-98 (DRS-R98), were pooled. Post hoc application of DRS-R98 item scores were used to rate DSM-5 criteria. ‘Strict’ and ‘relaxed’ DSM-5 criteria to ascertain delirium were compared to rates determined by DSM-IV.

Results

Using DSM-IV by clinical assessment, delirium was found in 510/768 patients (66%). Strict DSM-5 criteria categorized 158 as delirious including 155 (30%) with DSM-IV delirium, whereas relaxed DSM-5 criteria identified 466 as delirious, including 455 (89%) diagnosed by DSM-IV (P <0.001). The concordance between the different diagnostic methods was: 53% (ĸ = 0.22) between DSM-IV and the strict DSM-5, 91% (ĸ = 0.82) between the DSM-IV and relaxed DSM-5 criteria and 60% (ĸ = 0.29) between the strict versus relaxed DSM-5 criteria. Only 155 cases were identified as delirium by all three approaches. The 55 (11%) patients with DSM-IV delirium who were not rated as delirious by relaxed criteria had lower mean DRS-R98 total scores than those rated as delirious (13.7 ± 3.9 versus 23.7 ± 6.0; P <0.001). Conversely, mean DRS-R98 score (21.1 ± 6.4) for the 70% not rated as delirious by strict DSM-5 criteria was consistent with suggested cutoff scores for full syndromal delirium. Only 11 cases met DSM-5 criteria that were not deemed to have DSM-IV delirium.

Conclusions

The concordance between DSM-IV and the new DSM-5 delirium criteria varies considerably depending on the interpretation of criteria. Overly-strict adherence for some new text details in DSM-5 criteria would reduce the number of delirium cases diagnosed; however, a more ‘relaxed’ approach renders DSM-5 criteria comparable to DSM-IV with minimal impact on their actual application and is thus recommended.

【 授权许可】

   
2014 Meagher et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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