Nursing, UC San Diego Health   

Abstract

Objectives: To summarize the validity of caregiver‑centered delirium detection tools in hospitalized adults and assess associated patient and caregiver outcomes.

Design: Systematic review

Setting: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus from inception to May 15, 2017

Participants: Hospitalized adults

Intervention: Caregiver-centered delirium detection tools

Measurements: We drafted a protocol from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers independently completed abstract and full-text review, data extraction, and quality assessment. We summarized findings using descriptive statistics including mean, median, standard deviation, range, frequencies (percent), and Cohen's Kappa (κ). Included studies reported on the validity of caregiver-centered delirium detection tools or associated patient and caregiver outcomes, and were cohort or cross-sectional in design. 

Results: We reviewed 6056 titles and abstracts, included six articles, and identified six caregiver-centered tools. All tools were designed to be used in several minutes or less, and had 11 items or fewer. Three tools were caregiver-administered (completed independently by caregivers): Family Confusion Assessment Method (FAM-CAM), Informant Assessment of Geriatric Delirium (I-AGeD), and Sour Seven. Three tools were caregiver-informed (administered by a healthcare professional using caregiver input): Single Question in Delirium (SQiD), Single Screening Question Delirium (SSQ‑Delirium), and the Stressful Caregiving Response to Experiences of Dying (SCARED). Caregiver‑administered tools had higher psychometric properties [FAM-CAM sensitivity 75% (95%, confidence interval CI, 35-95%), specificity 91% (95% CI, 74-97%); Sour Seven positive predictive value, PPV 89.5%, negative predictive value, NPV 90%] than caregiver-informed tools [SQID: sensitivity 80% (95% CI, 28.3-99.5%), specificity 71% (95% CI, 58.77-99.8%), SSQ-Delirium sensitivity 79.6%, specificity 56.1%].

Conclusions: Delirium detection is essential for appropriate delirium management. Caregiver‑centered delirium detection tools are promising to improve delirium detection and associated patient and caregiver outcomes. Comparative studies utilizing larger sample sizes and multiple centers are required to determine validity and reliability characteristics.

Key Words: delirium; caregiver; family; hospital; screening