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Development and validation of the delirium risk assessment score (DRAS)

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Key summary points

AbstractSection Aim

To develop an easy-to-use delirium risk assessment score (DRAS) to establish if a patient admitted to a hospital is at risk of getting delirium.

AbstractSection Findings

Our delirium risk assessment score (DRAS) based on the admission interview showed that risk of delirium based on predisposing risk factors can be assessed easily without elaborate cognitive testing and/or laboratory results and therefore less stressful for the patient. The DRASs as good as or somewhat better than other risk assessment scores are not developed for one specific population.

AbstractSection Message

Because there is still a lack of knowledge, competence and awareness regarding delirium, understanding delirium risk factors helps clinicians, patients and caregivers in targeting non-pharmacological and pharmacological interventions aimed at lessening its burden.

Abstract

Purpose

Development and validation of a delirium risk assessment score. Predisposing risk factors for delirium were used, which are easily assessed at hospital admission without additional clinical or laboratory testing.

Methods

A systematic literature search identified ten risk factors: acute admission, alcohol use > 4 units/day, cognitive impairment, ADL impairment, age > 75 years, earlier delirium, hearing/vision problems, number of medication ≥ 5, number of morbidities > 2 and male. The DRAS was developed in a mixed patient population (N = 842) by the use of univariate and multivariate analyses and -2 log-likelihood calculation to weigh the risk factors. Based on the sensitivity and specificity, a cutoff score was calculated. The validation was performed in 3 cohorts (N = 408, N = 186, N = 365). In cohort 3, the DRAS was compared (AUC, sensitivity and specificity) to 3 instruments (Inouye, Kalisvaart, VMS rules).

Results

The delirium incidence was 31.8%, 20.3%, 15.6% and 15.1%. All risk factors were independently predictive for delirium, except male. The multivariate analyses excluded morbidities. The final DRAS consists of 8 items; acute admission, cognitive impairment, alcohol use (3 points), ADLimpairment/mobilityproblems (2 points), higher age, earlier delirium, hearing/vision problems, and medication (1 point). The total score is 15 points and at a cut-of score of 5 or higher the patient is at risk of developing a delirium. The cutoff was at 5 or more points, AUC: 0.76 (95% CI 0.72–0.79), sensitivity 0.77, specificity 0.60. Validation cohorts AUC was 0.75 (95% CI 0.96–0.81), 0.76 (95% CI 0.70–0.83) and 0.78 (95% CI 0.70–0.87), sensitivity 0.71, 0.67 and 0.89 and specificity 0.70, 0.72 and 0.60. The comparison revealed the highest AUC for the DRAS.

Conclusion

Based on an admission interview, the delirium risk can be easily evaluated using the DRAS shortlist score of predisposing risk factors for delirium in older inpatients.

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Acknowledgements

We would like to thank Karlijn van Stralen (MSc. PhD) of the Spaarne Gasthuis Academy for her help with the statistical calculations and the editing of the article during the process of writing.

Funding

The current study did not receive any grant or financial support.

Author information

Authors and Affiliations

  1. Department of Geriatric Medicine, Spaarne Gasthuis Haarlem, Boerhavelaan 22, 2035 RC, Haarlem, The Netherlands

    Ralph Vreeswijk & Kees J. Kalisvaart

  2. Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands

    Andrea B. Maier

  3. Health Care Inspectorate (IGJ), Stadsplateau 1, 3521 AZ, Utrecht, The Netherlands

    Imke Kalisvaart

  4. Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia

    Andrea B. Maier

Authors
  1. Ralph Vreeswijk
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  2. Imke Kalisvaart
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  3. Andrea B. Maier
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  4. Kees J. Kalisvaart
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Contributions

RV and KK conceived and designed the study. RV and IK are responsible for obtaining the data. RV, KK, AM were involved in the analysis and interpretation of data. RV, KK and AM drafted the manuscript. The study was supervised by KK and AM. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ralph Vreeswijk.

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Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

The studies were done in accordance with the Declaration of Helsinki and the guidelines on good clinical practice. Approval was obtained from the Advies Commissie Locale Uitvoerbaarheid (ACLU), the local committee of the METC of our hospital.

Informed consent

All patients and relatives were informed verbally. Patients and/or relatives gave their verbal consent for obtaining the data.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Vreeswijk, R., Kalisvaart, I., Maier, A.B. et al. Development and validation of the delirium risk assessment score (DRAS). Eur Geriatr Med 11, 307–314 (2020). https://doi.org/10.1007/s41999-019-00287-w

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  • DOI: https://doi.org/10.1007/s41999-019-00287-w

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