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

Thumbnail Image
DJM_ConcordancePV2014.pdf(996.82 KB)
Published Version
Meagher, David J.
Morandi, Alessandro
Inouye, Sharon K.
Ely, Wes
Adamis, Dimitrios
Maclullich, Alistair J.
Rudolph, James L.
Neufeld, Karin
Leonard, Maeve
Bellelli, Giuseppe
Journal Title
Journal ISSN
Volume Title
Biomed Central Ltd.
Research Projects
Organizational Units
Journal Issue
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.
Delirium , Classification , Diagnosis , Cognition , Neurocognitive disorders , Dementia , Medical inpatients , Scale-revised-98 , Confusion assessment method
MEAGHER, D. J., MORANDI, A., INOUYE, S. K., ELY, W., ADAMIS, D., MACLULLICH, A. J., RUDOLPH, J. L., NEUFELD, K., LEONARD, M., BELLELLI, G., DAVIS, D., TEODORCZUK, A., KREISEL, S., THOMAS, C., HASEMANN, W., TIMMONS, S., O’REGAN, N., GROVER, S., JABBAR, F., CULLEN, W., DUNNE, C., KAMHOLZ, B., VAN MUNSTER, B. C., DE ROOIJ, S. E., DE JONGHE, J. & TRZEPACZ, P. T. 2014. 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, 12:164 , 1-10.