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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*
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
David Garcia Nuñez
Affiliation:
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
Affiliation:
Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
Andre Richter
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
Maria Schubert
Affiliation:
University of Basel, University Hospital of Basel, Basel, Switzerland
David Meagher
Affiliation:
Graduate Entry Medical School, University of Limerick, Castletroy, Limerick, Ireland Department of Psychiatry, University Hospital of Limerick, Dooradoyle, Limerick, Ireland
Josef Jenewein
Affiliation:
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: soenke.boettger@usz.ch.

Abstract

Objective:

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.

Method:

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.

Results:

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2017 

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Footnotes

*

Shared first authorship

References

REFERENCES

Adamis, D., Scholtens, R.M., de Jonghe, A., et al. (2016). Psychometric evaluation of the DMSS–4 in a cohort of elderly post-operative hip fracture patients with delirium. International Psychogeriatrics, 28(7), 12211228. Epub ahead of print Feb 5.CrossRefGoogle Scholar
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th ed., Text Revision. Washington, DC: American Psychiatric Association.Google Scholar
Breitbart, W., Rosenfeld, B., Roth, A., et al. (1997). The Memorial Delirium Assessment Scale. Journal of Pain and Symptom Management, 13(3), 128137. Scale available from http://www.delirant.info/DreamHC/Download/MDAS.pdf.CrossRefGoogle ScholarPubMed
Camus, V., Gonthier, R., Dubos, G., et al. (2000). Etiologic and outcome profiles in hypoactive and hyperactive subtypes of delirium. Journal of Geriatric Psychiatry and Neurology, 13(1), 3842.CrossRefGoogle ScholarPubMed
de Rooij, S.E., van Munster, B.C., Korevaar, J.C., et al. (2006). Delirium subtype identification and the validation of the Delirium Rating Scale–Revised-98 (Dutch version) in hospitalized elderly patients. International Journal of Geriatric Psychiatry, 21(29), 876882.CrossRefGoogle ScholarPubMed
DeVellis, R.F. (2012). Scale development: Theory and applications. Thousand Oaks, CA: Sage Publications.Google Scholar
Fitzgerald, J., O'Regan, N., Adamis, D., et al. (2016). Concordance between the delirium motor subtyping scale (DMSS) and the abbreviated version (DMSS–4) over longitudinal assessment in elderly medical inpatients. International Psychogeriatrics, 28(5), 845851. Epub ahead of print Nov 26, 2015.CrossRefGoogle ScholarPubMed
Grover, S., Mattoo, S.K., Aarya, K.R., et al. (2013). Replication analysis for composition of the Delirium Motor Subtype Scale (DMSS) in a referral cohort from Northern India. Psychiatry Research, 206(1), 6874.CrossRefGoogle Scholar
Landis, J.R. & Koch, G.G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159174.CrossRefGoogle ScholarPubMed
Lipowski, Z.J. (1989). Delirium in the elderly patient. The New England Journal of Medicine, 320(9), 578582.Google ScholarPubMed
Liptzin, B. & Levkoff, S.E. (1992). An empirical study of delirium subtypes. The British Journal of Psychiatry, 161(6), 843845.CrossRefGoogle ScholarPubMed
Marcantonio, E., Ta, T., Duthie, E., et al. (2002). Delirium severity and psychomotor types: Their relationship with outcomes after hip fracture repair. Journal of the American Geriatrics Society, 50(5), 850857.CrossRefGoogle ScholarPubMed
Meagher, D. (2009). Motor subtypes of delirium: Past, present and future. International Review of Psychiatry, 21(1), 5973.CrossRefGoogle ScholarPubMed
Meagher, D., Moran, M., Raju, B., et al. (2008 a). A new data-based motor subtype schema for delirium. The Journal of .Neuropsychiatry and Clinical Neurosciences, 20(2), 185193. Available from http://neuro.psychiatryonline.org/doi/pdf/10.1176/jnp.2008.20.2.185.CrossRefGoogle ScholarPubMed
Meagher, D.J., Moran, M., Raju, B., et al. (2008 b). Motor symptoms in 100 patients with delirium versus control subjects: Comparison of subtyping methods. Psychosomatics, 49(4), 300308.CrossRefGoogle ScholarPubMed
Meagher, D.J., Leonard, M., Donnelly, S., et al. (2011). A longitudinal study of motor subtypes in delirium: Relationship with other phenomenology, etiology, medication exposure and prognosis. Journal of Psychosomatic Research, 71(6), 395403. Epub ahead of print Jul 2.CrossRefGoogle ScholarPubMed
Meagher, D., Adamis, D., Leonard, M., et al. (2014). Development of an abbreviated version of the Delirium Motor Subtyping Scale (DMSS–4). International Psychogeriatrics, 26(), 693702. Epub ahead of print Jan 16.CrossRefGoogle ScholarPubMed
O'Keeffe, S.T. & Lavan, J.N. (1999). Clinical significance of delirium subtypes in older people. Age and Ageing, 28(2), 115119. Available from http://ageing.oxfordjournals.org/content/28/2/115.long.CrossRefGoogle ScholarPubMed
Peterson, J.F., Pun, B.T., Dittus, R.S., et al. (2006). Delirium and its motoric subtypes: A study of 614 critically ill patients. Journal of the American Geriatrics Society, 54(3), 479484.CrossRefGoogle ScholarPubMed
Slor, C.J., Adamis, D., Jansen, R.W., et al. (2014). Validation and psychometric properties of the Delirium Motor Subtype Scale in elderly hip fracture patients (Dutch version). Archives of Gerontology and Geriatrics, 58(1), 140144. Epub ahead of print Aug 8, 2013.CrossRefGoogle ScholarPubMed
Stransky, M., Schmidt, C., Ganslmeier, P., et al. (2011). Hypoactive delirium after cardiac surgery as an independent risk factor for prolonged mechanical ventilation. Journal of Cardiothoracic and Vascular Anesthesia, 25(6), 968974. Epub ahead of print Jul 8.CrossRefGoogle ScholarPubMed
Trzepacz, P.T., Breitbart, W., Franklin, J., et al. (1999). Practice guideline for the treatment of patients with delirium: American Psychiatric Association. The American Journal of Psychiatry, 156(Suppl. 5), 120. Available from http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/delirium.pdf.Google Scholar
Trzepacz, P.T., Mittal, D., Torres, R., et al. (2001). Validation of the Delirium Rating Scale–Revised-98: Comparison with the Delirium Rating Scale and the Cognitive Test for Delirium. The Journal of Neuropsychiatry and Clinical Neurosciences, 13(2), 229242. Available from http://www.biama.org/pdfs/annual%20conference/annual%20conference%202015/annualconference2015handouts/WS06%20Delirium%20Rating%20Scale%20R98.pdf.CrossRefGoogle ScholarPubMed