Delirium Screening Tools Validated in the Context of Palliative Care: A Systematic Review

Palliative Medicine

Watt, C. L., Scott, M., et al. (2021).

Palliative Medicine, 35(4), 683-696.

<div>This systematic review investigates the validity of delirium screening tools in palliative care settings. Of note, although speech-language pathologists (SLPs) do not diagnose delirium, SLPs may administer delirium screening tools as part of a multidisciplinary effort to prevent and manage delirium.</div>

No funding received

From January 1, 1980 to May 3, 2020

<div>Primary quantitative research studies</div>

17

<div>This review reported the following psychometric properties for screening tools used to detect delirium in adults in palliative care settings:</div> <div> <ul> <li><strong>Bedside Confusion Scale:</strong> sensitivity of 100% and specificity of 54% with a cut-off score of &ge;1 and sensitivity of 100% and specificity of 85% with a cut-off score of &ge;2;</li> <li><strong>Brief CAM: </strong>sensitivity of 80% and specificity of 87%;</li> <li><strong>Communication Capacity Scale: </strong>sensitivity of 93.2% and specificity of 70.5% with a cut-off score of &ge;1 and sensitivity of 76.7% and specificity of 89.3% with a cut-off score of &ge;2;</li> <li><strong>Clinical Assessment of Confusion - A: </strong>sensitivity of 93.1% and specificity of 37%;</li> <li><strong>Clinical Assessment of Confusion - B: </strong>sensitivity of 89.7% and specificity of 76.1%;</li> <li><strong>Confusion Assessment Method (CAM): </strong>sensitivity of 88% and specificity of 100%;</li> <li><strong>Delirium Observation Screening Scale: </strong>sensitivity of 81.8%-99.9% and specificity of 89%-99.6% with a cut score &ge;3;</li> <li><strong>Delirium Rating Scale:</strong> sensitivity of 95% and specificity of 61% with a cut score 10 and sensitivity of 81% and specificity of 76% with a cut score 12;</li> <li><strong>Delirium Rating Scale - Revised 98: </strong>sensitivity of 56% and specificity of 82% with a cut score &ge;17.75;</li> <li><strong>Memorial Delirium Assessment Scale: </strong>sensitivity of 92.9%-97% and specificity of 71.8%-95% with a cut score &ge;7, sensitivity of 92%-95.8% and specificity of 90%-92.1% with a cut score &gt;9, and sensitivity of 68%-70.6% and specificity of 93.8%-94% with a cut score &ge;13;</li> <li><strong>Neelon and Champagne Confusion Scale:</strong> sensitivity of 89.7% and specificity of 69.6%;</li> <li><strong>Nursing Delirium Screening Scale: </strong>sensitivity of 63% and specificity of 67% when used by a nurse and sensitivity of 21%-35% and specificity of 80%-85% when used by care partners;</li> <li><strong>Single Question in Delirium: </strong>sensitivity of 80% and specificity of 71%; and</li> <li><strong>Visual Analog Scale for Acute Confusion:</strong> sensitivity of 96.6% and specificity of 80.5%.</li> </ul> <div>Limitations to this review included heterogeneity among patient populations, research methodology, and delirium detection tools in the included studies.</div> </div>