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Validation of a consensus method for identifying delirium from hospital records

Institution: Public Library of Science

Background: Delirium is increasingly considered to be an important determinant of trajectories of cognitive decline.
Therefore, analyses of existing cohort studies measuring cognitive outcomes could benefit from methods to ascertain a
retrospective delirium diagnosis. This study aimed to develop and validate such a method for delirium detection using
routine medical records in UK and Ireland.
Methods: A point prevalence study of delirium provided the reference-standard ratings for delirium diagnosis. Blinded to
study results, clinical vignettes were compiled from participants’ medical records in a standardised manner, describing any
relevant delirium symptoms recorded in the whole case record for the period leading up to case-ascertainment. An expert
panel rated each vignette as unlikely, possible, or probable delirium and disagreements were resolved by consensus.
Results: From 95 case records, 424 vignettes were abstracted by 5 trained clinicians. There were 29 delirium cases according
to the reference standard. Median age of subjects was 76.6 years (interquartile range 54.6 to 82.5). Against the original study
DSM-IV diagnosis, the chart abstraction method gave a positive likelihood ratio (LR) of 7.8 (95% CI 5.7–12.0) and the
negative LR of 0.45 (95% CI 0.40–0.47) for probable delirium (sensitivity 0.58 (95% CI 0.53–0.62); specificity 0.93 (95% CI
0.90–0.95); AUC 0.86 (95% CI 0.82–0.89)). The method diagnosed possible delirium with positive LR 3.5 (95% CI 2.9–4.3) and
negative LR 0.15 (95% CI 0.11–0.21) (sensitivity 0.89 (95% CI 0.85–0.91); specificity 0.75 (95% CI 0.71–0.79); AUC 0.86 (95% CI
Conclusions: This chart abstraction method can retrospectively diagnose delirium in hospitalised patients with good
accuracy. This has potential for retrospectively identifying delirium in cohort studies where routine medical records are
available. This example of record linkage between hospitalisations and epidemiological data may lead to further insights
into the inter-relationship between acute illness, as an exposure, for a range of chronic health outcomes.

Suggested citation:

. () Validation of a consensus method for identifying delirium from hospital records [Online]. Available from: [Accessed: 17th October 2019].


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