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Table 2 Classification performance for delirium diagnostic systems and their individual criteria as compared to cluster analysis-defined groups

From: Delirium diagnosis defined by cluster analysis of symptoms versus diagnosis by DSM and ICD criteria: diagnostic accuracy study

Classification Systems and their Criteria Whole sample (n = 200) Dementia subsample (n = 117)
Sensitivity % 95 % CI Specificity % 95 % CI Accuracy % 95 % CI Sensitivity % 95 % CI Specificity % 95 % CI Accuracy % 95 % CI
DSM-III-R 81.6 67.5–90.8 89.4 83.1–93.6 87.5 81.9–91.6 78.0 62.0–88.9 86.8 76.7–93.2 83.8 75.5–89.7
A Alteration to maintain and shift attention 85.7 [81.6] 72.1–93.6 84.1 [89.4] 77.1–89.4 84.5 [87.5] 78.6–89.1 82.9 [78.0] 67.3–92.3 78.9 [86.8] 67.8–87.1 80.3 [83.8] 71.8–86.9
B Disorganized thinking 89.8 [81.6] 77.0–96.2 79.5 [87.4] 72.0–85.4 82.0 [86.0] 75.8–86.9 87.8 [78.0] 73.0–95.4 68.4 [85.5] 56.6–78.3 75.2 [82.9] 66.2–82.5
C Alterations in two of: consciousness, perception, sleep – wake cycle, motor activity, orientation and memory. 100 [81.6] 90.9–99.8 43.7 [89.4] 35.7–52.0 57.5 [87.5] 50.3–64.4 100 [78.0] 89.3–99.8 18.4 [86.8] 10.8–29.3 47.0 [83.8] 37.8–56.4
D Acute onset and fluctuation tendency. 81.6 [83.7] 67.5–90.8 87.4 [88.1] 80.8–92.1 86.0 [87.0] 80.2–90.3 78.0 [80.5] 62.0–88.9 85.5 [84.2] 75.1–92.2 82.9 [82.9] 74.6–89.0
E Evidenced or presumed etiological cause. 83.7 [81.6] 69.8–92.2 80.8 [89.4] 73.4–86.6 81.5 [87.5] 75.3–86.5 80.5 [78.0] 64.6–90.6 78.9 [86.8] 67.8–87.1 79.5 [83.8] 70.8–86.2
DSM-IV 71.4 56.5–83.0 90.7 84.6–94.6 86.0 80.2–90.3 65.9 49.3–79.4 90.8 81.4–95.9 82.1 73.6–88.3
A Disturbance of consciousness and attention 83.7 [73.5] 69.8–92.2 87.4 [88.7] 80.8–92.1 86.5 [85.0] 80.8–90.8 80.5 [68.3] 64.6–90.6 84.2 [88.2] 73.6–91.2 82.9
[81.2]
74.6–89.0
B Cognition alteration or perceptual disturbance, not explained by a dementia. 83.7 [73.5] 69.8–92.2 80.1 [90.7] 72.7–86.0 81.0 [86.5] 74.7–86.0 80.5 [68.3] 64.6–90.6 78.9 [90.8] 67.8–87.1 79.5 [82.9] 70.8–86.2
C Acute onset and fluctuation tendency. 83.7 [71.4] 69.8–92.2 88.1 [89.4] 81.6–92.6 87.0 [85.0] 81.3–91.2 80.5 [65.9] 64.6–90.6 86.8 [88.2] 76.7–93.2 84.6 [80.3] 76.5–90.4
D Evidence for etiology. 75.5 [79.6] 60.8–86.2 81.5 [90.7] 74.1–87.1 80.0 [88.0] 73.6–85.2 70.7 [75.6] 54.3–83.3 80.3 [90.8] 69.2–88.2 76.9 [85.5] 68.0–84.0
DSM-5 73.5 58.7–84.6 88.1 81.6–92.6 84.5 78.6–89.1 68.3 51.8–81.4 86.8 76.7–93.2 80.3 71.8–86.9
A Disturbance in attention and awareness. 85.7 [73.5] 72.1–93.6 86.1 [88.1] 79.3–91.0 86.0 [84.5] 80.2–90.3 82.9 [68.3] 67.3–92.3 82.9 [86.8] 72.2–90.2 82.9 [80.3] 74.6–89.0
B Acute onset and fluctuation tendency. 83.7 [73.5] 69.8–92.2 88.1 [86.8] 81.6–92.6 87.0 [83.5] 81.3–91.2 80.5 [68.3] 64.6–90.6 86.8 [84.2] 76.7–93.2 84.6 [78.6] 76.5–90.4
C Additional cognitive change or perception disturbance. 98.0 [73.5] 87.8–99.9 36.4 [88.1] 28.9–44.7 51.5 [84.5] 44.4–58.6 97.6 [68.3] 85.6–99.9 14.5 [86.8] 7.8–24.8 43.6 [80.3] 34.5–53.1
D No better explanation by another neurocognitive disorder nor reduced level of arousal. 81.6 [75.5] 67.5–90.8 84.1 [88.1] 77.1–89.4 83.5 [85.0] 77.5–88.2 78.0 [70.7] 62.0–88.9 82.9 [86.8] 72.2–90.2 81.2 [81.2] 72.7–87.6
E Evidence for etiology. 75.5 [81.6] 60.8–86.2 81.5 [88.1] 74.1–87.1 80.0 [86.5] 73.6–85.2 70.7 [78.0] 54.3–83.3 80.3 [86.8] 69.2–88.2 76.9 [83.8] 68.0–84.0
ICD-10 53.1 38.4–67.2 96.0 91.2–98.4 85.5 79.7–89.9 48.8 33.1–64.6 93.4 84.7–97.5 77.8 69.0–84.7
A Clouding of consciousness and attention alteration. 81.6 [55.1] 67.5–90.8 90.1 [94.0] 83.9–94.1 88.0 [84.5] 82.5–92.0 78.0 [51.2] 62.0–88.9 88.2 [90.8] 78.2–94.1 84.6 [76.9] 76.5–90.4
B Disturbance of cognition (memory and orientation). 98.0 [55.1] 87.8–99.9 49.0 [96.0] 40.8–57.2 61.0 [86.0] 53.8–67.7 97.6 [51.2] 85.6–99.9 22.4 [93.4] 13.9–33.6 48.7 [78.6] 39.4–58.1
C One psychomotor disturbance (shifts from hypo to hyperactivity, reaction time increased, speech increased /decreased, enhanced startle reaction) 95.9 [53.1] 84.9–99.3 66.2 [96.0] 58.0–73.6 73.5 [85.5] 66.7–79.4 95.1 [48.8] 82.2–99.1 57.9 [93.4] 46.0–68.9 70.9 [77.8] 61.7–78.8
D Sleep-wake alteration (includes nocturnal worsening and hypnopompic disturbances) 71.4 [67.3] 56.5–83.0 72.2 [92.7] 64.2–79.0 72.0 [86.5] 65.1–78.0 70.7 [63.4] 54.3–83.3 61.8 [92.1] 49.9–72.5 65.0 [82.1] 55.5–73.4
E Rapid onset and fluctuations. 77.6 [53.1] 63.0–87.7 89.4 [95.4] 83.1–93.6 86.5 [85.0] 80.8–90.8 75.6 [48.8] 59.4–87.1 88.2 [92.1] 78.2–94.1 83.8 [76.9] 75.5–89.7
F Evidence for an etiologic cause. 77.6 [59.2] 63.0–87.7 80.1 [96.0] 72.7–86.0 79.5 [87.0] 73.1–84.7 73.2 [56.1] 56.8–85.2 76.3 [93.4] 64.9–85.0 75.2 [80.3] 66.2–82.5
  1. Cluster analysis-defined groups were identified using DRS-R98 items. Performance characteristics and 95 % confidence intervals (95 % CI) are given for each classification system. Performance values for the diagnostic criteria after each individual criterion was excluded are noted within brackets. Bolded values denote when the percentage of correctly classified cases (accuracy) as compared to the reference standard are significant at p < 0.05 according to the Wald test