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

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dc.contributor.authorMeagher, David J.
dc.contributor.authorMorandi, Alessandro
dc.contributor.authorInouye, Sharon K.
dc.contributor.authorEly, Wes
dc.contributor.authorAdamis, Dimitrios
dc.contributor.authorMaclullich, Alistair J.
dc.contributor.authorRudolph, James L.
dc.contributor.authorNeufeld, Karin
dc.contributor.authorLeonard, Maeve
dc.contributor.authorBellelli, Giuseppe
dc.contributor.authorDavis, Daniel
dc.contributor.authorTeodorczuk, Andrew
dc.contributor.authorKreisel, Stefan
dc.contributor.authorThomas, Christine
dc.contributor.authorHasemann, Wolfgang
dc.contributor.authorTimmons, Suzanne
dc.contributor.authorO'Regan, Niamh
dc.contributor.authorGrover, Sandeep
dc.contributor.authorJabbar, Faiza
dc.contributor.authorCullen, Walter
dc.contributor.authorDunne, Colum P.
dc.contributor.authorKamholz, Barbara
dc.contributor.authorVan Munster, Barbara C.
dc.contributor.authorde Rooij, Sophie E.
dc.contributor.authorde Jonghe, Jos
dc.contributor.authorTrepacz, Paula T.
dc.contributor.funderJohns Hopkins University, United Statesen
dc.contributor.funderWellcome Trust, United Kingdomen
dc.contributor.funderSwiss Alzheimer Association
dc.contributor.funderAlzheimervereinigung beider Basel, Switzerland
dc.contributor.funderHealth Research Boarden
dc.contributor.funderAll-Ireland Institute of Palliative Careen
dc.date.accessioned2016-01-21T09:32:33Z
dc.date.available2016-01-21T09:32:33Z
dc.date.issued2014-09-30
dc.description.abstractBACKGROUND: 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.en
dc.description.sponsorshipJohns Hopkins University, United States (from Ornim Medical LTD. PI Mandal); Wellcome Trust, United Kingdom (Research Training Fellowship (WT090661)); Health Research Board; All-Ireland Institute of Palliative Careen
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleid164
dc.identifier.citationMEAGHER, 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. http://dx.doi.org/10.1186/s12916-014-0164-8en
dc.identifier.doi10.1186/s12916-014-0164-8
dc.identifier.endpage10en
dc.identifier.issn1741-7015
dc.identifier.journaltitleBMC Medicineen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/2206
dc.identifier.volume12en
dc.language.isoenen
dc.publisherBiomed Central Ltd.en
dc.rights© 2014 Meagher et al.; licensee BioMed Central Ltd., 2014. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectDeliriumen
dc.subjectClassificationen
dc.subjectDiagnosisen
dc.subjectCognitionen
dc.subjectNeurocognitive disordersen
dc.subjectDementiaen
dc.subjectMedical inpatientsen
dc.subjectScale-revised-98en
dc.subjectConfusion assessment methoden
dc.titleConcordance 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-98en
dc.typeArticle (peer-reviewed)en
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