An empirical study of different diagnostic criteria for delirium among elderly medical inpatients.
This study compared the sensitivity and specificity of DSM-IV criteria for delirium with the sensitivity and specificity of DSM-III and ICD-10 criteria among elderly medical inpatients with or without dementia. Secondary objectives were to examine the effect of changing the definition of criterion A on sensitivity and specificity and to compare the sensitivity and specificity of different numbers of symptoms of delirium. A total of 322 elderly patients who had been admitted from the emergency department to the medical services were classified into one of four groups using DSM-III-R criteria: delirium and dementia (n = 128), delirium only (n = 40), dementia only (n = 94), and neither (n = 60). The sensitivity and specificity of DSM-IV, DSM-III, and ICD-10 criteria were determined against DSM-III-R criteria using three definitions of criterion A (clouding of consciousness only, clouding of consciousness and inattention, clouding of consciousness or inattention). When criterion A was defined as clouding of consciousness or inattention, the sensitivity and specificity of DSM-IV, DSM-III, and ICD-10 criteria were 100% and 71%, 96% and 91%, and 61% and 91%, respectively. The results were similar among patients with or without dementia. The lower specificity of DSM-IV was accounted for by its inclusion of patients who did not show disorganized thinking. DSM-IV criteria for delirium are the most inclusive criteria to date for elderly medical patients with or without dementia.
Department of Psychiatry, St. Mary's Hospital and McGill University, Montreal, Quebec. martin.cole@ssss.gouv.qc.ca
Martin G
MG
Cole
Nandini
N
Dendukuri
Jane
J
McCusker
Ling
L
Han
D000368:Aged; D000369:Aged, 80 and over; D003221:Confusion / Q000453:epidemiology; D003693:Delirium / Q000175:diagnosis*; D003704:Dementia / Q000175:diagnosis; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D036262:Empirical Research; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007297:Inpatients; D038801:International Classification of Diseases / Q000592:standards; D008297:Male; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000592:standards; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity