Delirium Item Bank: Utilization to Evaluate and Create Delirium Instruments

Area of Science:

• Geriatric Medicine
• Psychometrics
• Clinical Assessment

Background:

• Numerous heterogeneous instruments for delirium identification hinder study comparison and result aggregation.
• A systematic review recommended four well-validated instruments, leading to the development of the Delirium Item Bank (DEL-IB) using advanced psychometric methods.

Purpose of the Study:

• To identify optimal cut-points for four existing delirium assessment instruments.
• To demonstrate the utility of the DEL-IB in creating new, potentially more effective, delirium identification instruments.

Main Methods:

• Secondary analysis and simulation study using data from 600 hospitalized older adults across three countries.
• Evaluated performance of Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria, Confusion Assessment Method (long/short), Delirium Observation Screening Scale, Delirium Rating Scale-Revised-98, and Memorial Delirium Assessment Scale (MDAS).

Main Results:

• Optimized cut-points were identified for existing instruments, improving sensitivity and specificity (e.g., MDAS cut-point of 6 yielded 89% sensitivity, 79% specificity).
• Four new example instruments (short and long forms) were created using the DEL-IB, demonstrating strong performance characteristics (e.g., example short form: 90% sensitivity, 81% specificity).

Conclusions:

• The DEL-IB enhances understanding of delirium instrument psychometric performance.
• The DEL-IB facilitates the creation of optimized delirium identification tools and promotes a unified approach to delirium assessment.