{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:48:55Z","timestamp":1792788535866,"version":"4.5.0"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T00:00:00Z","timestamp":1650240000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical Services Incorporated Foundation"},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007582","name":"Alberta Health Services","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007582","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100020977","name":"Canadian Frailty Network","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100020977","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000161","name":"Networks of Centres of Excellence of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000161","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CIHR Doctoral Research Award"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fluctuating course of delirium and complexities of ICU care mean delirium symptoms are hard to identify or commonly confused with other disorders. Delirium is difficult to diagnose, and clinicians and researchers may combine assessments from multiple tools. We evaluated diagnostic accuracy of different combinations of delirium assessments performed in each enrolled patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were obtained from a previously conducted cross-sectional study. Eligible adult patients who remained admitted to ICU for &gt;24 hours with at least one family member present were consecutively enrolled as patient-family dyads. Clinical delirium assessments (Intensive Care Delirium Screening Checklist [ICSDC] and Confusion Assessment Method-ICU [CAM-ICU]) were completed twice daily by bedside nurse or trained research assistant, respectively. Family delirium assessments (Family Confusion Assessment Method and Sour Seven) were completed once daily by family members. We pooled all delirium assessment tools in a single two-class latent model and pairwise (i.e., combined, clinical or family assessments) Bayesian analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventy-three patient-family dyads were included. Among clinical delirium assessments, the ICDSC had lower sensitivity (0.72; 95% Bayesian Credible [BC] interval 0.54\u20130.92) and higher specificity (0.90; 95%BC, 0.82\u20130.97) using Bayesian analyses compared to pooled latent class analysis and CAM-ICU had higher sensitivity (0.90; 95%BC, 0.70\u20131.00) and higher specificity (0.94; 95%BC, 0.80\u20131.00). Among family delirium assessments, the Family Confusion Assessment Method had higher sensitivity (0.83; 95%BC, 0.71\u20130.92) and higher specificity (0.93; 95%BC, 0.84\u20130.98) using Bayesian analyses compared to pooled latent class analysis and the Sour Seven had higher specificity (0.85; 95%BC, 0.67\u20130.99) but lower sensitivity (0.64; 95%BC 0.47\u20130.82).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Results from delirium assessment tools are often combined owing to imperfect reference standards for delirium measurement. Pairwise Bayesian analyses that explicitly accounted for each tool\u2019s (performed within same patient) prior sensitivity and specificity indicate that two combined clinical or two combined family delirium assessment tools have fair diagnostic accuracy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0267110","type":"journal-article","created":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T13:27:10Z","timestamp":1650288430000},"page":"e0267110","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":21,"title":["Delirium diagnosis without a gold standard: Evaluating diagnostic accuracy of combined delirium assessment tools"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1157-884X","authenticated-orcid":true,"given":"Stephana 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care unit","volume":"74","author":"LM Bigatello","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"issue":"1","key":"pone.0267110.ref007","doi-asserted-by":"crossref","first-page":"38","DOI":"10.4037\/ccn2018633","article-title":"Delirium Assessment Tools for Use in Critically Ill Adults: A Psychometric Analysis and Systematic Review","volume":"38","author":"C Gelinas","year":"2018","journal-title":"Crit Care Nurse"},{"issue":"7","key":"pone.0267110.ref008","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1097\/CCM.0000000000004367","article-title":"Partnering With Family Members to Detect Delirium in Critically Ill Patients","volume":"48","author":"KM Fiest","year":"2020","journal-title":"Crit Care Med"},{"issue":"12","key":"pone.0267110.ref009","doi-asserted-by":"crossref","first-page":"2196","DOI":"10.1007\/s00134-013-3105-7","article-title":"The accurate recognition of delirium in the ICU: the emperor\u2019s new clothes?","volume":"39","author":"JW Devlin","year":"2013","journal-title":"Intensive Care Med"},{"issue":"2","key":"pone.0267110.ref010","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1055\/s-0033-1342972","article-title":"Delirium monitoring in the ICU: strategies for initiating and sustaining screening efforts","volume":"34","author":"BT Pun","year":"2013","journal-title":"Semin Respir Crit Care Med"},{"issue":"1","key":"pone.0267110.ref011","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/s12916-019-1367-9","article-title":"Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method","volume":"17","author":"SD Shenkin","year":"2019","journal-title":"BMC Med"},{"issue":"24","key":"pone.0267110.ref012","doi-asserted-by":"crossref","first-page":"4141","DOI":"10.1002\/sim.6218","article-title":"Estimation of diagnostic test accuracy without full verification: a review of latent class methods","volume":"33","author":"J Collins","year":"2014","journal-title":"Stat Med"},{"issue":"1","key":"pone.0267110.ref013","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1002\/sim.4780050105","article-title":"The value of latent class analysis in medical diagnosis","volume":"5","author":"D Rindskopf","year":"1986","journal-title":"Stat Med"},{"issue":"1","key":"pone.0267110.ref014","doi-asserted-by":"crossref","first-page":"167","DOI":"10.2307\/2530508","article-title":"Estimating the error rates of diagnostic tests","volume":"36","author":"SL Hui","year":"1980","journal-title":"Biometrics"},{"key":"pone.0267110.ref015","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.3389\/fpsyg.2018.01240","article-title":"Application of Bayes\u2019 Theorem in Valuating Depression Tests Performance","volume":"9","author":"M Tommasi","year":"2018","journal-title":"Front Psychol"},{"key":"pone.0267110.ref016","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.jcrc.2018.07.021","article-title":"Secondary EMR data for quality improvement and research: A comparison of manual and electronic data collection from an integrated critical care electronic medical record system","volume":"47","author":"R Brundin-Mather","year":"2018","journal-title":"J Crit Care"},{"issue":"2","key":"pone.0267110.ref017","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1378\/chest.06-1795","article-title":"The importance of diagnosing and managing ICU delirium","volume":"132","author":"BT Pun","year":"2007","journal-title":"Chest"},{"issue":"5","key":"pone.0267110.ref018","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/s001340100909","article-title":"Intensive Care Delirium Screening Checklist: evaluation of a new screening tool","volume":"27","author":"N Bergeron","year":"2001","journal-title":"Intensive Care Med"},{"issue":"11","key":"pone.0267110.ref019","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.1111\/j.1532-5415.2012.04200.x","article-title":"Screening for delirium using family caregivers: convergent validity of the Family Confusion Assessment Method and interviewer-rated Confusion Assessment Method","volume":"60","author":"MR Steis","year":"2012","journal-title":"J Am Geriatr Soc"},{"key":"pone.0267110.ref020","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s12877-016-0217-2","article-title":"Validation of the Sour Seven Questionnaire for screening delirium in hospitalized seniors by informal caregivers and untrained nurses","volume":"16","author":"RW Shulman","year":"2016","journal-title":"BMC Geriatr"},{"issue":"7","key":"pone.0267110.ref021","article-title":"A Pairwise Naive Bayes Approach to Bayesian Classification","volume":"29","author":"JK Asafu-Adjei","year":"2015","journal-title":"Intern J Pattern Recognit Artif Intell"},{"key":"pone.0267110.ref022","unstructured":"Chang C, editor Response feature analysis of longitudinal data in medical research2000."},{"key":"pone.0267110.ref023","unstructured":"Linzer DAaJ, L. poLCA: Polytomous Variable Latent Class Analysis.\u201d R package version 1.4 2013. https:\/\/cran.r-project.org\/web\/packages\/poLCA\/README.html."},{"issue":"11","key":"pone.0267110.ref024","doi-asserted-by":"crossref","DOI":"10.18637\/jss.v032.i11","article-title":"Bayesian Functional Data Analysis Using WinBUGS","volume":"32","author":"CM Crainiceanu","year":"2010","journal-title":"J Stat Softw"},{"key":"pone.0267110.ref025","unstructured":"Estimation of Disease Prevalence and the Parameters of One, Two or Three Diagnostic Tests. http:\/\/www.medicine.mcgill.ca\/epidemiology\/Joseph\/software\/BayesDiagnosticTests\/InstallInstructions.html."},{"issue":"3","key":"pone.0267110.ref026","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1093\/oxfordjournals.aje.a117428","article-title":"Bayesian estimation of disease prevalence and the parameters of diagnostic tests in the absence of a gold standard","volume":"141","author":"L Joseph","year":"1995","journal-title":"Am J Epidemiol"},{"issue":"5","key":"pone.0267110.ref027","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1176\/ajp.151.5.650","article-title":"Measuring diagnostic accuracy in the absence of a \"gold standard\"","volume":"151","author":"SV Faraone","year":"1994","journal-title":"Am J Psychiatry"},{"issue":"9","key":"pone.0267110.ref028","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/0895-4356(88)90110-2","article-title":"Estimation of test error rates, disease prevalence and relative risk from misclassified data: a review","volume":"41","author":"SD Walter","year":"1988","journal-title":"J Clin Epidemiol"},{"issue":"1","key":"pone.0267110.ref029","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1111\/j.0006-341X.2001.00158.x","article-title":"Bayesian approaches to modeling the conditional dependence between multiple diagnostic tests","volume":"57","author":"N Dendukuri","year":"2001","journal-title":"Biometrics"},{"key":"pone.0267110.ref030","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.psychres.2018.03.003","article-title":"The use of latent class analysis for identifying subtypes of depression: A systematic review","volume":"266","author":"CM Ulbricht","year":"2018","journal-title":"Psychiatry Res"},{"key":"pone.0267110.ref031","unstructured":"Vats D, Knudson C. Revisiting the Gelman-Rubin Diagnostic2018."},{"issue":"11","key":"pone.0267110.ref032","doi-asserted-by":"crossref","first-page":"e0242378","DOI":"10.1371\/journal.pone.0242378","article-title":"The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients","volume":"15","author":"KD Krewulak","year":"2020","journal-title":"PLoS One"},{"issue":"2","key":"pone.0267110.ref033","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1111\/j.0006-341X.2004.00183.x","article-title":"Bayesian sample size determination for prevalence and diagnostic test studies in the absence of a gold standard test","volume":"60","author":"N Dendukuri","year":"2004","journal-title":"Biometrics"},{"issue":"2","key":"pone.0267110.ref034","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.jpainsymman.2013.10.024","article-title":"Practical assessment of delirium in palliative care","volume":"48","author":"MM Leonard","year":"2014","journal-title":"J Pain Symptom Manage"},{"issue":"3","key":"pone.0267110.ref035","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1097\/SPC.0000000000000062","article-title":"Delirium diagnosis, screening and management","volume":"8","author":"PG Lawlor","year":"2014","journal-title":"Curr Opin Support Palliat Care"},{"issue":"12","key":"pone.0267110.ref036","doi-asserted-by":"crossref","first-page":"941","DOI":"10.7326\/0003-4819-113-12-941","article-title":"Clarifying confusion: the confusion assessment method. A new method for detection of delirium","volume":"113","author":"SK Inouye","year":"1990","journal-title":"Ann Intern Med"},{"issue":"8","key":"pone.0267110.ref037","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1111\/j.1532-5415.2012.04066.x","article-title":"Diagnosing delirium in older hospitalized adults with dementia: adapting the confusion assessment method to international classification of diseases, tenth revision, diagnostic criteria","volume":"60","author":"C Thomas","year":"2012","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"pone.0267110.ref038","doi-asserted-by":"crossref","first-page":"E294","DOI":"10.9778\/cmajo.20180123","article-title":"Feasibility and acceptability of family administration of delirium detection tools in the intensive care unit: a patient-oriented pilot study","volume":"7","author":"KD Krewulak","year":"2019","journal-title":"CMAJ Open"},{"issue":"11","key":"pone.0267110.ref039","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1097\/CCM.0000000000003349","article-title":"Delirium Monitoring in Neurocritically Ill Patients: A Systematic Review","volume":"46","author":"MB Patel","year":"2018","journal-title":"Crit Care Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0267110","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,19]],"date-time":"2023-11-19T23:06:08Z","timestamp":1700435168000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0267110"}},"subtitle":[],"editor":[{"given":"Enrico","family":"Mossello","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,4,18]]},"references-count":39,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0267110","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,18]]}}}