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Brief assessment of delirium subtypes: Psychometric evaluation of the Delirium Motor Subtype Scale (DMSS)–4 in the intensive care setting

Published online by Cambridge University Press:  12 January 2017

Soenke Boettger*
Department of Psychiatry and Psychotherapy, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
David Garcia Nuñez
Department of Psychiatry and Psychotherapy, University Hospital of Zurich, University of Zurich, Zurich, Switzerland University of Basel, University Hospital of Basel, Basel, Switzerland
Rafael Meyer
Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
Andre Richter
Department of Psychiatry and Psychotherapy, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
Maria Schubert
University of Basel, University Hospital of Basel, Basel, Switzerland
David Meagher
Graduate Entry Medical School, University of Limerick, Castletroy, Limerick, Ireland Department of Psychiatry, University Hospital of Limerick, Dooradoyle, Limerick, Ireland
Josef Jenewein
Department of Psychiatry and Psychotherapy, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
Address correspondence and reprint requests to Soenke Boettger, Department of Psychiatry and Psychotherapy, University Hospital of Zurich, University of Zurich, Ramistraase 100, 8091 Zurich, Switzerland. E-mail:



The management of and prognosis for delirium are affected by its subtype: hypoactive, hyperactive, mixed, and none. The DMSS–4, an abbreviated version of the Delirium Motor Symptom Scale, is a brief instrument for the assessment of delirium subtypes. However, it has not yet been evaluated in an intensive care setting.


We performed a prospective/descriptive cohort study in order to determine the internal consistency, reliability, and validity of the relevant items of the DMSS–4 versus the Delirium Rating Scale–Revised-98 (DRS–R-98) and the original DMSS in a surgical intensive care setting.


A total of 289 elderly, predominantly male patients were screened for delirium, and 122 were included in our sample. The internal consistency of the DMSS–4 items was excellent (Cronbach's α = 0.92), and between the DMSS–4 and DRS–R-98 the overall concurrent validity was substantial (Cramer's V = 0.67). Within individual motor subtypes, concurrent validity remained at least substantial (Cohen's κ = 0.65–0.81) and sensitivity high (69.8 to 82.2%), in contrast to those of the no-motor subtype, with less validity and sensitivity (κ = 0.28, 22%). Similarly, total concurrent validity between the DMSS–4 and the original DMSS reached perfection (Cramer's V = 0.83), as did agreement between the subtypes (κ = 0.83–0.92), while sensitivity remained high (88.2–100%). Only in those with delirium with no-motor subtype was agreement moderate (κ = 0.56) and sensitivity lower (67%). Specificity was high across all subtypes (91.2–99.1%). The DMSS–4 yielded very sensitive ratings, particularly for hypoactive and hyperactive motor symptoms, and interrater agreement was excellent (Fleiss's κ = 0.83).

Significance of Results:

We found the DMSS–4 to be a most reliable and valid brief assessment of delirium in characterizing the subtypes of delirium in an intensive care setting, with increased sensitivity to hypoactive and hyperactive motor alterations.

Original Articles
Copyright © Cambridge University Press 2017 

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