title: Serial administration of a modified Richmond Agitation and Sedation Scale for delirium screening.
abstract: OBJECTIVE
  Because delirium is a common yet frequently unrecognized condition, this study sought to design a brief screening tool for a core feature of mental status and to validate the instrument as a serial assessment for delirium.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary VA Hospital in New England.
  
  
  METHODS
  A total of 95 veterans admitted to the medical service.
  
  
  METHODS
  A consensus panel developed a modified version of the Richmond Agitation and Sedation Scale (RASS) to capture alterations in consciousness. Upon admission, and daily thereafter, patients were screened with a modified RASS (mRASS) and independently underwent a comprehensive mental status interview by a geriatric expert, who determined whether the criteria for delirium were met. The sensitivity, specificity, and positive likelihood ratio (LR) of the mRASS for delirium are reported.
  
  
  RESULTS
  As a single assessment, the mRASS had a sensitivity of 64% and a specificity of 93% for delirium (LR, 9.4). When used to detect change, serial mRASS assessments had a sensitivity of 74% and a specificity of 92% (LR, 8.9) in both prevalent and incident delirium. When prevalent cases were excluded, any change in the mRASS had a sensitivity of 85% and a specificity of 92% for incident delirium (LR, 10.2)
  
  
  CONCLUSIONS
  When administered daily, the mRASS has good sensitivity and specificity for incident delirium. Given the brevity of the instrument (<30 seconds), consideration should be given to incorporating the modified RASS as a daily screening measure for consciousness and delirium.
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Chester
authors.forename: Mary
authors.initials: M
authors.lastname: Beth Harrington
authors.forename: James L
authors.initials: JL
authors.lastname: Rudolph
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011595:Psychomotor Agitation / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology