title: Delirium diagnosis methodology used in research: a survey-based study.
abstract: OBJECTIVE
  To describe methodology used to diagnose delirium in research studies evaluating delirium detection tools.
  
  
  METHODS
  The authors used a survey to address reference rater methodology for delirium diagnosis, including rater characteristics, sources of patient information, and diagnostic process, completed via web or telephone interview according to respondent preference. Participants were authors of 39 studies included in three recent systematic reviews of delirium detection instruments in hospitalized patients.
  
  
  RESULTS
  Authors from 85% (N = 33) of the 39 eligible studies responded to the survey. The median number of raters per study was 2.5 (interquartile range: 2-3); 79% were physicians. The raters' median duration of clinical experience with delirium diagnosis was 7 years (interquartile range: 4-10), with 5% having no prior clinical experience. Inter-rater reliability was evaluated in 70% of studies. Cognitive tests and delirium detection tools were used in the delirium reference rating process in 61% (N = 21) and 45% (N = 15) of studies, respectively, with 33% (N = 11) using both and 27% (N = 9) using neither. When patients were too drowsy or declined to participate in delirium evaluation, 70% of studies (N = 23) used all available information for delirium diagnosis, whereas 15% excluded such patients.
  
  
  CONCLUSIONS
  Significant variability exists in reference standard methods for delirium diagnosis in published research. Increasing standardization by documenting inter-rater reliability, using standardized cognitive and delirium detection tools, incorporating diagnostic expert consensus panels, and using all available information in patients declining or unable to participate with formal testing may help advance delirium research by increasing consistency of case detection and improving generalizability of research results.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: kneufel2@jhmi.edu.
authors.forename: Karin J
authors.initials: KJ
authors.lastname: Neufeld
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Archana
authors.initials: A
authors.lastname: Nelliot
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Institute for Aging Research, Hebrew Senior Life, Boston, MA.
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
authors.affiliation: Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Center for Health Services Research, Vanderbilt School of Medicine, Nashville, TN; Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN.
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: O Joseph
authors.initials: OJ
authors.lastname: Bienvenu
authors.affiliation: Psychological Medicine Service, Yale-New Haven Hospital, New Haven, CT.
authors.forename: Hochang Benjamin
authors.initials: HB
authors.lastname: Lee
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D035843:Biomedical Research / Q000295:instrumentation / Q000379:methods*; D003693:Delirium / Q000145:classification / Q000175:diagnosis*; D005853:Geriatrics / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry / Q000295:instrumentation / Q000379:methods*
keywords: Delirium; amnestic; cognitive disorders; data collection; dementia; reference standards; research design
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