Comparison of three scores to screen for delirium in the recovery room

• Published in: British journal of anaesthesia : BJA Vol. 101; no. 3; pp. 338 - 343
• Main Authors: Radtke, F.M., Franck, M., Schneider, M., Luetz, A., Seeling, M., Heinz, A., Wernecke, K.D., Spies, C.D.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.09.2008; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; cognitive; complications; complications, neurological; Delirium - diagnosis; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Male; Medical sciences; Middle Aged; neurological; postoperative; Postoperative Complications - diagnosis; Psychiatric Status Rating Scales; recovery; Recovery Room; recovery, cognitive; recovery, postoperative; Reproducibility of Results; Sensitivity and Specificity; recovery, cognitive; complications, neurological; recovery, postoperative; Delirium; Postoperative; complications; neurological; recovery; cognitive; recovery; Anesthesia; Complication; Medical screening; Mental confusion; Comparative study; Organic mental disorder
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aen193

Delirium is often seen in the recovery room and is a predictor for postoperative delirium on the ward. However, monitoring to detect delirium in the recovery room as a basic prerequisite for early intervention is rarely used. The aim of this study was to identify a valid and easy-to-use test for early screening of delirium in the recovery room. One hundred and fifty-four adult patients admitted to the recovery room during regular working hours were included. A screening assessment for delirium was performed in the recovery room by a trained research team at the time when the patient was judged to be ‘ready for discharge’. Delirium monitoring was performed with the Confusion Assessment Method (CAM), the Delirium Detection Score (DDS), and the Nursing Delirium Screening Scale (Nu-DESC). The Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria were used as the gold standard. Delirium in the recovery room was seen in 21 patients (14%) with the DSM-IV criteria, in 11 patients (7%) with the CAM, in four patients (3%) with the DDS, and in 37 patients (24%) with the Nu-DESC. Sensitivity and specificity were 0.43 and 0.98 for the CAM, 0.14 and 0.99 for the DDS, and 0.95 and 0.87 for the Nu-DESC, respectively. All scores used were very specific, but the CAM and the DDS were less sensitive compared with the gold standard. Overall, the Nu-DESC was the most sensitive test in the recovery room to detect delirium.