J Korean Clin Nurs Res.  2025 Apr;31(1):24-34. 10.22650/JKCNR.2025.31.1.24.

Comparison of Validity of Delirium Assessment Tools in Elderly Inpatients with Stroke

• Lee S
• Kim JS

• KMID: 2567675
• DOI: http://doi.org/10.22650/JKCNR.2025.31.1.24

Abstract

Purpose
This study aimed to identify the most delirium assessment tool with high predictive validity for elderly patients with stroke.
Methods
This was a prospective observational study. The subjects were 219 stroke patients aged 60 years or older admitted to the neurology ward of a general hospital and data collection was conducted from August 2022 to February 2023. The collected data were analyzed using descriptive statistics, x 2 -test, independent t-test, and Fisher's exact test. The predictive validity of the Delirium Observation Screening Scale (DOS), the Nursing Delirium Screening Scale(Nu-DESC), and the 4'A's test (4AT) were assessed based on the sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC).
Results
Of the 38 patients screened for delirium using delirium assessment tools, 32 (14.6%) were diagnosed with delirium by a neurologist. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.4%, 91.1%, 71.1%, and 97.2% for DOS; 93.8%, 96.8%, 83.3%, and 98.9% for Nu-DESC; and 100.0%, 96.8%, 84.2%, and 100.0% for 4AT, respectively. The AUC was shown to be 0.89 for the DOS, 0.95 for the Nu-DESC, and 0.98 for the 4AT.
Conclusion
The results indicate that the 4AT was the most valid delirium assessment tool for elderly patients with stroke. Therefore, the active use of 4AT by nurses to screen for delirium of elderly stroke patients in clinical settings can contribute to the prevention and early management of delirium.

Keyword

Aged; Aged; Delirium; Delirium; Nursing Assessment; Nursing Assessment; Stroke; Stroke