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Brief Report
Serial administration of a modified richmond agitation and sedation scale for delirium screening
Article first published online: 15 DEC 2011
DOI: 10.1002/jhm.1003
Copyright © 2012 Society of Hospital Medicine
Additional Information
How to Cite
Chester, J. G., Beth Harrington, M., Rudolph, J. L. and on behalf of the VA Delirium Working Group (2012), Serial administration of a modified richmond agitation and sedation scale for delirium screening. J. Hosp. Med., 7: 450–453. doi: 10.1002/jhm.1003
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Tel.: 857-364-6812; Fax: 857-364-4544
Publication History
- Issue published online: 6 JUN 2012
- Article first published online: 15 DEC 2011
- Manuscript Accepted: 27 OCT 2011
- Manuscript Revised: 18 OCT 2011
- Manuscript Received: 21 MAY 2011
Abstract
OBJECTIVES:
Because delirium is a common yet frequently unrecognized condition, this study sought to design a brief screening tool for a core feature of mental status and to validate the instrument as a serial assessment for delirium.
DESIGN:
Prospective cohort study.
SETTING:
Tertiary VA Hospital in New England.
PARTICIPANTS:
A total of 95 veterans admitted to the medical service.
METHODS:
A consensus panel developed a modified version of the Richmond Agitation and Sedation Scale (RASS) to capture alterations in consciousness. Upon admission, and daily thereafter, patients were screened with a modified RASS (mRASS) and independently underwent a comprehensive mental status interview by a geriatric expert, who determined whether the criteria for delirium were met. The sensitivity, specificity, and positive likelihood ratio (LR) of the mRASS for delirium are reported.
RESULTS:
As a single assessment, the mRASS had a sensitivity of 64% and a specificity of 93% for delirium (LR, 9.4). When used to detect change, serial mRASS assessments had a sensitivity of 74% and a specificity of 92% (LR, 8.9) in both prevalent and incident delirium. When prevalent cases were excluded, any change in the mRASS had a sensitivity of 85% and a specificity of 92% for incident delirium (LR, 10.2)
CONCLUSION:
When administered daily, the mRASS has good sensitivity and specificity for incident delirium. Given the brevity of the instrument (<30 seconds), consideration should be given to incorporating the modified RASS as a daily screening measure for consciousness and delirium. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine