Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar;39(3):240-249.
doi: 10.1177/08850666231199986. Epub 2023 Sep 5.

The Validity and Applicability of the Revised Delirium Rating Scale (DRS-R98) for Delirium Severity Assessment in a Critical Care Setting

Eiman Saeed Almuhairi  1 , Monica Badejo  2 , Aneesa Peer  3 , Mervi Pitkanen  1   4 , Cathrine A McKenzie  1   4   5   6   7
Affiliations

The Validity and Applicability of the Revised Delirium Rating Scale (DRS-R98) for Delirium Severity Assessment in a Critical Care Setting

Eiman Saeed Almuhairi et al. J Intensive Care Med. 2024 Mar.

Abstract

Background: Delirium is a neuropsychiatric syndrome common in critical illness. Worsening delirium severity is associated with poorer clinical outcomes, yet its assessment remains under-reported with most severity assessment tools not validated for critical care. The DRS-R98 is a widely applied and validated tool. The aim of this project is to report the validation and utility of the DRS-R98 in critical illness.

Methods: This prospective, cohort study was conducted in adults with delirium admitted to a critical care unit and predicted to stay for ≥ 24 h. We excluded patients with severe neurological or communication barriers that would have interfered with the DRS-R98 assessment. Patients were screened using a delirium detection algorithm and the Confusion Assessment Method for the Intensive Care Unit. Eligible patient informations were collected and reported to qualified assessor/s before visiting clinical areas, confirming delirium presence and undertaking DRS- R98 assessments. To assess the tool's construct validity, an intensivist completed the Clinical Global Impression-Scale (CGI-S). To calculate the inter-rater reliability (IRR) a subset of patients were simultaneously evaluated by two assessors.

Results: We assessed 22 patients, 73% were male, with a median age of 65 years (IQR14). The DRS -R98 mean (SD) severity score was 24 (+/-7.7), total scale was 29 (+/18.0), and CGI-S 3.5 (+/11.5). Assessment duration was 90 min (+/-55) and 15 min (+/-5) for record data extraction and clinical assessment respectively. The CGI-S significantly correlated with DRS-R98 severity (r = 0.626) and total (r = 0.628) scales. The DRS-R98 Cronbach's alpha was 0.896 for severity scale and 0.886 for total scale. The inter-rater reliability (IRR) was assessed in six patients and reported an inter-correlation coefficient of 0.505 (p = 0.124) and 0.565 (p = 0.93) for the severity and total scale respectively.

Conclusions: In critical care, the Delirium Rating Scale R98 had good construct validity, excellent internal consistency, and moderate inter-rater reliability.

Keywords: critical care; delirium; intensive care; severity; validation.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
DRS-R98 process, from screening to validation.
Figure 2.
Figure 2.
DRS-R98indivdual components and subclassifications.
Figure 3.
Figure 3.
DRS-R98 assessment location, duration and impacting factors.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Ely EW, Girard TD, Shintani AK, et al. Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients. Crit Care Med. 2007;35(1):112-117. - PubMed
    1. Zaal IJ, Spruyt CF, Peelen LM, et al. Intensive care unit environment may affect the course of delirium. Intensive Care Med. Mar 2013;39(3):481-488. doi:10.1007/s00134-012-2726-6 - DOI - PubMed
    1. Vasilevskis EE, Han JH, Hughes CG, Ely EW. Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol. 2012;26(3):277-287. 10.1016/j.bpa.2012.07.003 - DOI - PMC - PubMed
    1. Adamis D, Sharma N, Whelan PJP, MacDonald AJD. Delirium scales: A review of current evidence. Aging Ment Health. 2010;14(5):543-555. doi:10.1080/13607860903421011 - DOI - PubMed
    1. Rosgen BK, Krewulak KD, Stelfox HT, et al. The association of delirium severity with patient and health system outcomes in hospitalised patients: a systematic review. Age Ageing. 2020; 49(4):549–557. doi:10.1093/ageing/afaa053 - DOI - PMC - PubMed