Table 3.
Comparison of 6 top-rated delirium severity instruments (alphabetical order)*
| Delirium Severity Instrument, year of publication, (Sample size) | Recommended Time to Complete | Qualifications of Raters (original study) | Provides Diagnosis by Criteria† | COSMIN rating, (best=6) | Construct Validity‡ | Prediction of clinical outcomes | No. domains covered | Relative Cost Estimate§ |
|---|---|---|---|---|---|---|---|---|
| Confusion Assessment Method (CAM-S), 2014 (N = 919 + 300) | 10–15 minutes (long form) | Trained lay or clinical raters | Y | 5 | r=.64 with MMSE r=.64-.80 with global confusion rating |
Y | 9 | $ |
| Confusional State Examination (CSE), 1997 (N = 51) | 30 minutes | Trained nurse, psychologist or physician | N | 5.5 | r=.87 with MMSE r=.79 with CGR |
N | 12 | $$ |
| Delirium-O-Meter (DOM), 2005 (N = 92) | <5 minutes | Nurses without specialized training | N | 4.5 | r=.83 with MMSE r=.87 with DRS |
N | 12 | $$ |
| Delirium Observation Scale (DOS), 2003 (N = 92) | < 5 minutes | Nurses without specialized training | N | 6 | r=.60-.79 with MMSE r=.63 with CAM r=.33-.74 with IQCODE |
N | 10 | $$ |
| Delirium Rating Scale (DRS-R-98), 2001 (N= 26) | 20–30 minutes (scoring), following ~1 hour (gathering information from nurse, family, chart) | Psychiatrically trained clinicians | Y | 3.5 | r=.43 with MMSE | N | 11 | $$$ |
| Memorial Delirium Assessment Scale (MDAS), 1997 (N = 30) | 10–15 minutes (scoring), following15–30 minutes (interview, information from nurse, family, chart) | Trained clinicians | N | 5 | r=.91 with MMSE r=.88 with DRS |
N | 10 | $$ |
All instruments included in this table are available for free (no licensing cost) and can be accessed online. Specific copyright information on each is available at: https://deliriumnetwork.org/measurement/delirium-info-cards/ Selection criteria for final instruments: (1) used in at least 2 or more articles; (2) COSMIN rating of 3.5 or greater; (3) strong evidence of construct and/or predictive validity; and (4) broad domain coverage of 9 or more domains. Only one validation study per instrument was reviewed for this study, either original validation or first available study after adaptation, see text for details. All of these instruments scored severity using counts of either number of domains, intensity of each domain, or both on a continuous scale.
Diagnosis by specific pre-specified criteria, not by cut-point alone
r = correlation coefficient, with >0.7 indicating a strong relationship; >0.5 indicating a moderate relationship; and >0.3 indicating a weak relationship.
Relative cost determined from administration time and required level of clinical training of interviewer (e.g., clinician assigned higher relative cost than lay rater)