The delirium observation screening scale recognizes delirium early after cardiac surgery

Eur J Cardiovasc Nurs. 2009 Oct;8(4):309-14. doi: 10.1016/j.ejcnurse.2009.02.006. Epub 2009 Mar 12.


Background: Delirium or acute confusion is a temporary mental disorder which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. Prevention or early recognition of delirium is essential. The Delirium Observation Screening (DOS) scale was developed to facilitate early recognition of delirium by nurses' observations during routine clinical care.

Aim: The aim of this study was to validate the DOS scale in accordance with the diagnosis of the psychiatrist, using the DSM-IV criteria as the gold standard.

Methods: In this observational study, the DOS scale was used to assess whether 112 patients who underwent elective cardiac surgery had developed a postoperative delirium. The psychiatrist was consulted to confirm or refute the diagnosis delirium. Wilcoxon's Rank Sum Test was utilized to compare patients with and without delirium on duration of hospital stay. A Receiver Operating Characteristic Curve of the DOS scale was constructed with accompanying Area Under the Curve (AUC).

Results: Based on the diagnosis of the psychiatrist, the incidence of delirium following cardiac surgery was 21.4% and the mean duration of delirium was two and a half days. The time to discharge was 11 days longer in patients with delirium. In 27 of the 112 patients a DOS score of >or=3 was found, that indicates delirium. The sensitivity and specificity of the DOS scale was 100% and 96.6% respectively. The AUC was 0.98.

Conclusion: The DOS scale is a very good instrument to facilitate early recognition of delirium by nurses' observation of patients who undergo cardiac surgery. Early recognition will expedite good postoperative management such as implementation of appropriate interventions, and may decrease negative consequences caused by postoperative delirium.

Publication types

  • Validation Study

MeSH terms

  • Aged
  • Cardiac Surgical Procedures / adverse effects*
  • Cardiac Surgical Procedures / nursing
  • Cardiac Surgical Procedures / statistics & numerical data
  • Delirium / diagnosis*
  • Delirium / epidemiology
  • Delirium / nursing*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Neuropsychological Tests / standards*
  • Neuropsychological Tests / statistics & numerical data
  • Nursing Assessment / standards*
  • Nursing Assessment / statistics & numerical data
  • Perioperative Nursing / methods
  • Postoperative Care / methods
  • Postoperative Care / nursing
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology
  • Postoperative Complications / nursing
  • Prevalence
  • Reproducibility of Results
  • Sensitivity and Specificity