title: Recognizing acute delirium as part of your routine [RADAR]: a validation study.
abstract: BACKGROUND
  Although detection of delirium using the current tools is excellent in research settings, in routine clinical practice, this is not the case. Together with nursing staff, we developed a screening tool (RADAR) to address certain limitations of existing tools, notably administration time, ease-of-use and generalizability. The purpose of this study was not only to evaluate the validity and reliability of RADAR but also to gauge its acceptability among the nursing staff in two different clinical settings.
  
  
  METHODS
  This was a validation study conducted on three units of an acute care hospital (medical, cardiology and coronary care) and five units of a long-term care facility. A total of 142 patients and 51 residents aged 65 and over, with or without dementia, participated in the study and 139 nurses were recruited and trained to use the RADAR tool. Data on each patient/resident was collected over a 12-hour period. The nursing staff and researchers administered RADAR during the scheduled distribution of medication. Researchers used the Confusion Assessment Method to determine the presence of delirium symptoms. Delirium itself was defined as meeting the criteria for DMS-IV-TR delirium. Inter-rater reliability, convergent, and concurrent validity of RADAR were assessed. At study end, 103 (74%) members of the nursing staff completed the RADAR feasibility and acceptability questionnaire.
  
  
  RESULTS
  Percentages of agreement between RADAR items that bedside nurses administered and those research assistants administered varied from 82% to 98%. When compared with DSM-IV-TR criterion-defined delirium, RADAR had a sensitivity of 73% and a specificity of 67%. Participating nursing staff took about seven seconds on average, to complete the tool and it was very well received (≥98%) overall.
  
  
  CONCLUSIONS
  The RADAR tool proved to be efficient, reliable, sensitive and very well accepted by nursing staff. Consequently, it becomes an appropriate new option for delirium screening among older adults, with or without cognitive impairment, in both hospitals and nursing homes. Further projects are currently underway to validate the RADAR among middle-aged adults, as well as in newer clinical settings; home care, emergency department, medical intensive care unit, and palliative care.
authors.affiliation: Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, room 3445, 1050, rue de la Médecine, Quebec City, Quebec Canada ; Centre d'excellence sur le vieillissement de Québec, Quebec City, Quebec Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Voyer
authors.affiliation: Institut Universitaire de Gériatrie de Montréal, Département de médecine familiale, Montreal University, Montreal, Quebec Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Champoux
authors.affiliation: Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Quebec Canada.
authors.forename: Johanne
authors.initials: J
authors.lastname: Desrosiers
authors.affiliation: École de psychologie, Laval University, Quebec City, Quebec Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Landreville
authors.affiliation: St. Mary's Research Centre, St Mary's Hospital, Montreal, Quebec Canada ; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: McCusker
authors.affiliation: Division of Geriatric Medicine, Jewish General Hospital and Donald Berman Maimonides Geriatric Center, Montreal, Quebec Canada.
authors.forename: Johanne
authors.initials: J
authors.lastname: Monette
authors.affiliation: Ste. Anne Hospital, McGill University, Montreal, Quebec Canada.
authors.forename: Maryse
authors.initials: M
authors.lastname: Savoie
authors.affiliation: Centre d'excellence sur le vieillissement de Québec, Quebec City, Quebec Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Richard
authors.affiliation: Centre d'excellence sur le vieillissement de Québec, Quebec City, Quebec Canada.
authors.forename: Pierre-Hugues
authors.initials: PH
authors.lastname: Carmichael
keywords: Acute care; Cognitive impairment; Delirium; Elderly; Long-term care; Screening tool
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