title: Delirium assessment in hospitalized elderly patients: Italian translation and validation of the nursing delirium screening scale.
abstract: BACKGROUND
  Delirium has a high incidence pathology associated with negative outcomes. Although highly preventable, half the cases are not recognized. One major cause of delirium misdiagnosis is the absence of a versatile instrument to measure it.
  
  
  OBJECTIVE
  Our objective was to translate the nursing delirium screening scale (Nu-DESC) and evaluate its performance in Italian settings.
  
  
  METHODS
  This was a methodological study conducted in two sequential phases. The first was the Italian translation of Nu-DESC through a translation and back-translation process. The second aimed to test the inter-rater reliability, the sensibility and specificity of the instrument on a convenience sample of 101 hospitalized elderly people admitted to relevant wards of the San Gerardo Hospital in Monza. To evaluate the inter-rater reliability, two examiners tested Nu-DESC on 20 patients concurrently without comparison. To measure the sensibility and specificity of Nu-DESC, the confusion assessment method was used as a gold standard measure.
  
  
  RESULTS
  The inter-rater reliability (Cohen Kappa) was 0.87-an excellent agreement between examiners. The study of the ROC curve showed an AUC value of 0.9461 suggesting high test accuracy. Using 3 as a cut-off value, Nu-DESC showed 100 % sensibility and 76 % specificity.
  
  
  CONCLUSIONS
  Further research is needed to test Nu-DESC on a larger sample. However, based on our results, Nu-DESC can be used in research and clinical practice in Italian settings because of its very good and similar performances to previous validation studies. The value of 3 appears to be the optimal cut-off in the Italian context.
authors: Azienda Socio Sanitaria Territoriale - ASST Monza, Università degli Studi di Milano-Bicocca, Monza, Italy. v.spedale@asst-monza.it.
authors: Valentina
authors: V
authors: Spedale
authors: Dipartimento di Scienze della Salute, Università degli Studi di Milano-Bicocca, Monza, Italy.
authors: Stefania
authors: S
authors: Di Mauro
authors: Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), Monza, Italy.
authors: Giulia
authors: G
authors: Del Giorno
authors: Azienda Socio Sanitaria Territoriale - ASST Monza, Università degli Studi di Milano-Bicocca, Monza, Italy.
authors: Monica
authors: M
authors: Barilaro
authors: Azienda Socio Sanitaria Territoriale - ASST Monza, Università degli Studi di Milano-Bicocca, Monza, Italy.
authors: Candida E
authors: CE
authors: Villa
authors: Psychiatrist Laval University, Quebec City, Canada.
authors: Jean D
authors: JD
authors: Gaudreau
authors: Dipartimento di Scienze della Salute, Università degli Studi di Milano-Bicocca, Monza, Italy.
authors: Davide
authors: D
authors: Ausili
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003693:Delirium / Q000175:diagnosis*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007558:Italy; D008297:Male; D008609:Mental Status Schedule; D009730:Nursing Assessment / Q000379:methods*; D012372:ROC Curve; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014177:Translations
keywords: Confusion assessment method; Delirium; Delirium assessment; Nursing assessment; Nursing delirium screening scale; Validation study