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Attention! A good bedside test for delirium?

Niamh A O'Regan1, Daniel J Ryan1, Eve Boland2

  • 1Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.

Journal of Neurology, Neurosurgery, and Psychiatry
|February 27, 2014
PubMed
Summary

Simple attention tests like Months of the Year Backwards (MOTYB) are effective for delirium screening. Combining MOTYB with confusion assessment offers the highest accuracy in general hospital patients.

Keywords:
ATTENTIONCOGNITIONNEUROPSYCHIATRY

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Area of Science:

  • Geriatric Medicine
  • Neuroscience
  • Clinical Diagnostics

Background:

  • Delirium detection is crucial but optimal screening tools remain unclear.
  • Existing screening methods require evaluation for diagnostic accuracy.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of specific screening methods for delirium.
  • To compare the effectiveness of individual and combined screening tools.

Main Methods:

  • Cross-sectional study of 265 adult inpatients.
  • Screening using Months of the Year Backwards (MOTYB), Spatial Span Forwards (SSF), and confusion assessment.
  • Formal delirium assessment using Confusion Assessment Method (CAM) and Delirium Rating Scale-Revised 98 (DRS-R98).

Main Results:

  • Simultaneous MOTYB and confusion assessment showed high precision (sensitivity 93.8%, specificity 84.7%).
  • MOTYB alone was most accurate for older patients; SSF combined with MOTYB or confusion assessment was best for younger patients.
  • Adding CAM as a second-line step reduced sensitivity significantly.

Conclusions:

  • Simple attention tests are valuable for delirium screening.
  • MOTYB alone is the most accurate screening test for older individuals.