title: Concordance between the delirium motor subtyping scale (DMSS) and the abbreviated version (DMSS-4) over longitudinal assessment in elderly medical inpatients.
abstract: BACKGROUND
  Delirium is a common neuropsychiatric syndrome that includes clinical subtypes identified by the Delirium Motor Subtyping Scale (DMSS). We explored the concordance between the DMSS and an abbreviated 4-item version in elderly medical inpatients.
  
  
  METHODS
  Elderly general medical admissions (n = 145) were assessed for delirium using the Revised Delirium Rating scale (DRS-R98). Clinical subtype was assessed with the DMSS (which includes the four items included in the DMSS-4). Motor subtypes were generated for all patient assessments using both versions of the scale. The concordance of the original and abbreviated DMSS was examined.
  
  
  RESULTS
  The agreement between the DMSS and DMSS-4 was high, both at initial and subsequent assessments (κ range 0.75-0.91). Intraclass Correlation Coefficient (ICC) for all three raters for the DMSS was high (0.70) and for DMSS-4 was moderate (0.59). Analysis of the agreement between raters for individual DMSS items found higher concordance in respect of hypoactive features compared to hyperactive.
  
  
  CONCLUSIONS
  The DMSS-4 allows for rapid assessment of clinical subtype in delirium and has high concordance with the longer and well-validated DMSS, including over longitudinal assessment. There is good inter-rater reliability between medical and nursing staff. More consistent clinical subtyping can facilitate better delirium management and more focused research effort.
authors.affiliation: Graduate-entry Medical School,University of Limerick,Limerick,Ireland.
authors.forename: James
authors.initials: J
authors.lastname: Fitzgerald
authors.affiliation: Centre for Gerontology and Rehabilitation,St. Finbarr's Hospital,Cork,Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: O'Regan
authors.affiliation: Cognitive Impairment Research Group,Centre for Interventions in Infection,Inflammation & Immunity (4i),Graduate Entry Medical School,University of Limerick,Ireland.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Adamis
authors.affiliation: Centre for Gerontology and Rehabilitation,St. Finbarr's Hospital,Cork,Ireland.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Timmons
authors.affiliation: Graduate-entry Medical School,University of Limerick,Limerick,Ireland.
authors.forename: Colum
authors.initials: C
authors.lastname: Dunne
authors.affiliation: Indiana University School of Medicine,Indianapolis,Indiana,USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Trzepacz
authors.affiliation: Graduate-entry Medical School,University of Limerick,Limerick,Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Meagher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000145:classification / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007494:Ireland; D008297:Male; D009043:Motor Activity; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D015203:Reproducibility of Results; D012720:Severity of Illness Index
keywords: activity; assessment; delirium; motor; phenomenology; subtypes