title: Concordance between DSM-IV and DSM-5 criteria for delirium diagnosis in a pooled database of 768 prospectively evaluated patients using the delirium rating scale-revised-98.
abstract: BACKGROUND
  The Diagnostic and Statistical Manual fifth edition (DSM-5) provides new criteria for delirium diagnosis. We examined delirium diagnosis using these new criteria compared with the Diagnostic and Statistical Manual fourth edition (DSM-IV) in a large dataset of patients assessed for delirium and related presentations.
  
  
  METHODS
  Patient data (n = 768) from six prospectively collected cohorts, clinically assessed using DSM-IV and the Delirium Rating Scale-Revised-98 (DRS-R98), were pooled. Post hoc application of DRS-R98 item scores were used to rate DSM-5 criteria. 'Strict' and 'relaxed' DSM-5 criteria to ascertain delirium were compared to rates determined by DSM-IV.
  
  
  RESULTS
  Using DSM-IV by clinical assessment, delirium was found in 510/768 patients (66%). Strict DSM-5 criteria categorized 158 as delirious including 155 (30%) with DSM-IV delirium, whereas relaxed DSM-5 criteria identified 466 as delirious, including 455 (89%) diagnosed by DSM-IV (P <0.001). The concordance between the different diagnostic methods was: 53% (ĸ = 0.22) between DSM-IV and the strict DSM-5, 91% (ĸ = 0.82) between the DSM-IV and relaxed DSM-5 criteria and 60% (ĸ = 0.29) between the strict versus relaxed DSM-5 criteria. Only 155 cases were identified as delirium by all three approaches. The 55 (11%) patients with DSM-IV delirium who were not rated as delirious by relaxed criteria had lower mean DRS-R98 total scores than those rated as delirious (13.7 ± 3.9 versus 23.7 ± 6.0; P <0.001). Conversely, mean DRS-R98 score (21.1 ± 6.4) for the 70% not rated as delirious by strict DSM-5 criteria was consistent with suggested cutoff scores for full syndromal delirium. Only 11 cases met DSM-5 criteria that were not deemed to have DSM-IV delirium.
  
  
  CONCLUSIONS
  The concordance between DSM-IV and the new DSM-5 delirium criteria varies considerably depending on the interpretation of criteria. Overly-strict adherence for some new text details in DSM-5 criteria would reduce the number of delirium cases diagnosed; however, a more 'relaxed' approach renders DSM-5 criteria comparable to DSM-IV with minimal impact on their actual application and is thus recommended.
authors.forename: David J
authors.initials: DJ
authors.lastname: Meagher
authors.forename: Alessandro
authors.initials: A
authors.lastname: Morandi
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
authors.forename: Wes
authors.initials: W
authors.lastname: Ely
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Adamis
authors.forename: Alasdair J
authors.initials: AJ
authors.lastname: Maclullich
authors.forename: James L
authors.initials: JL
authors.lastname: Rudolph
authors.forename: Karin
authors.initials: K
authors.lastname: Neufeld
authors.forename: Maeve
authors.initials: M
authors.lastname: Leonard
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellelli
authors.forename: Daniel
authors.initials: D
authors.lastname: Davis
authors.forename: Andrew
authors.initials: A
authors.lastname: Teodorczuk
authors.forename: Stefan
authors.initials: S
authors.lastname: Kreisel
authors.forename: Christine
authors.initials: C
authors.lastname: Thomas
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hasemann
authors.forename: Suzanne
authors.initials: S
authors.lastname: Timmons
authors.forename: Niamh
authors.initials: N
authors.lastname: O'Regan
authors.forename: Sandeep
authors.initials: S
authors.lastname: Grover
authors.forename: Faiza
authors.initials: F
authors.lastname: Jabbar
authors.forename: Walter
authors.initials: W
authors.lastname: Cullen
authors.forename: Colum
authors.initials: C
authors.lastname: Dunne
authors.forename: Barbara
authors.initials: B
authors.lastname: Kamholz
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Van Munster
authors.forename: Sophia E
authors.initials: SE
authors.lastname: De Rooij
authors.forename: Jos
authors.initials: J
authors.lastname: De Jonghe
authors.forename: Paula T
authors.initials: PT
authors.lastname: Trzepacz
mesh_terms: D000293:Adolescent; D000328:Adult; D003693:Delirium / Q000145:classification* / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male