Diagnostic test accuracy of a novel smartphone application for the assessment of attention deficits in delirium in older hospitalised patients: a prospective cohort study protocol

Lisa-Marie Rutter, Eva Nouzova, David Stott, Christopher J. Weir, Valentina Assi, Jennifer Barnett, Caoimhe Clarke, Nikki Duncan, Jonathan Evans, Samantha Green, Kirsty Hendry, Meigan McGinlay, Jenny McKeever, Duncan Middleton, Stuart Parks, Robert Shaw, Elaine Tang, Timothy Walsh, Alexander Weir, Elizabeth WilsonTara Quasim, Alasdair MacLullich, Zoe Tieges*

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

BACKGROUND:
Delirium is a common and serious clinical syndrome which is often missed in routine clinical care. The core cognitive feature is inattention. We developed a novel bedside neuropsychological test for assessing inattention in delirium implemented on a smartphone platform (DelApp). We aim to evaluate the diagnostic performance of the DelApp in a representative cohort of older hospitalised patients.

METHODS:
This is a prospective study of older non-scheduled hospitalised patients (target n = 500, age ≥ 65), recruited from elderly care and acute orthopaedic wards. Exclusion criteria are: non-English speakers; severe vision or hearing impairment; photosensitive epilepsy. A structured reference standard delirium assessment based on DSM-5 criteria will be used, which includes a cognitive test battery administered by a trained assessor (Orientation-Memory-Concentration Test, Abbreviated Mental Test-10, Delirium Rating Severity Scale-Revised-98, digit span, months and days backwards, Vigilance A' test) and assessment of arousal (Observational Scale of Level of Arousal, Richmond Agitation Sedation Scale). Prior change in cognition will be documented using the Informant Questionnaire on Cognitive Decline in the Elderly. Patients will be categorized as delirium (with/without dementia), possible delirium, dementia, no cognitive impairment, or undetermined. A separate assessor (blinded to diagnosis and assessments) will administer the DelApp index test within 3 h of the reference standard assessment. The DelApp comprises assessment of arousal (score 0-4) and sustained attention (score 0-6), yielding a total score between 0 and 10 (higher score = better performance). Outcomes (length of stay, mortality and discharge location) will be collected at 12 weeks. We will evaluate a priori cutpoints derived from a previous case-control study. Measures of the accuracy of DelApp will include sensitivity, specificity, positive and negative predictive values, and area under the ROC curve. We plan repeat assessments on up to 4 occasions in a purposive subsample of 30 patients (15 delirium, 15 no delirium) to examine changes over time.

DISCUSSION:
This study evaluates the diagnostic test accuracy of a novel smartphone test for delirium in a representative cohort of older hospitalised patients, including those with dementia. DelApp has the potential to be a convenient, objective method of improving delirium assessment for older people in acute care.

TRIAL REGISTRATION:
Clinical trials.gov, NCT02590796 . Registered on 29 Oct 2015. Protocol version 5, dated 25 July 2016.
Original languageEnglish
Article number217
JournalBMC Geriatrics
Volume18
DOIs
Publication statusPublished - 17 Sep 2018

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Delirium
Routine Diagnostic Tests
Cohort Studies
Prospective Studies
Arousal
Dementia
Reflex Epilepsy
Smartphone
Intelligence Tests
Neuropsychological Tests
Hearing Loss
ROC Curve
Cognition
Area Under Curve
Orthopedics
Case-Control Studies
Length of Stay
Clinical Trials
Sensitivity and Specificity
Mortality

Cite this

Rutter, Lisa-Marie ; Nouzova, Eva ; Stott, David ; Weir, Christopher J. ; Assi, Valentina ; Barnett, Jennifer ; Clarke, Caoimhe ; Duncan, Nikki ; Evans, Jonathan ; Green, Samantha ; Hendry, Kirsty ; McGinlay, Meigan ; McKeever, Jenny ; Middleton, Duncan ; Parks, Stuart ; Shaw, Robert ; Tang, Elaine ; Walsh, Timothy ; Weir, Alexander ; Wilson, Elizabeth ; Quasim, Tara ; MacLullich, Alasdair ; Tieges, Zoe. / Diagnostic test accuracy of a novel smartphone application for the assessment of attention deficits in delirium in older hospitalised patients: a prospective cohort study protocol. In: BMC Geriatrics. 2018 ; Vol. 18.
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abstract = "BACKGROUND:Delirium is a common and serious clinical syndrome which is often missed in routine clinical care. The core cognitive feature is inattention. We developed a novel bedside neuropsychological test for assessing inattention in delirium implemented on a smartphone platform (DelApp). We aim to evaluate the diagnostic performance of the DelApp in a representative cohort of older hospitalised patients.METHODS:This is a prospective study of older non-scheduled hospitalised patients (target n = 500, age ≥ 65), recruited from elderly care and acute orthopaedic wards. Exclusion criteria are: non-English speakers; severe vision or hearing impairment; photosensitive epilepsy. A structured reference standard delirium assessment based on DSM-5 criteria will be used, which includes a cognitive test battery administered by a trained assessor (Orientation-Memory-Concentration Test, Abbreviated Mental Test-10, Delirium Rating Severity Scale-Revised-98, digit span, months and days backwards, Vigilance A' test) and assessment of arousal (Observational Scale of Level of Arousal, Richmond Agitation Sedation Scale). Prior change in cognition will be documented using the Informant Questionnaire on Cognitive Decline in the Elderly. Patients will be categorized as delirium (with/without dementia), possible delirium, dementia, no cognitive impairment, or undetermined. A separate assessor (blinded to diagnosis and assessments) will administer the DelApp index test within 3 h of the reference standard assessment. The DelApp comprises assessment of arousal (score 0-4) and sustained attention (score 0-6), yielding a total score between 0 and 10 (higher score = better performance). Outcomes (length of stay, mortality and discharge location) will be collected at 12 weeks. We will evaluate a priori cutpoints derived from a previous case-control study. Measures of the accuracy of DelApp will include sensitivity, specificity, positive and negative predictive values, and area under the ROC curve. We plan repeat assessments on up to 4 occasions in a purposive subsample of 30 patients (15 delirium, 15 no delirium) to examine changes over time.DISCUSSION:This study evaluates the diagnostic test accuracy of a novel smartphone test for delirium in a representative cohort of older hospitalised patients, including those with dementia. DelApp has the potential to be a convenient, objective method of improving delirium assessment for older people in acute care.TRIAL REGISTRATION:Clinical trials.gov, NCT02590796 . Registered on 29 Oct 2015. Protocol version 5, dated 25 July 2016.",
author = "Lisa-Marie Rutter and Eva Nouzova and David Stott and Weir, {Christopher J.} and Valentina Assi and Jennifer Barnett and Caoimhe Clarke and Nikki Duncan and Jonathan Evans and Samantha Green and Kirsty Hendry and Meigan McGinlay and Jenny McKeever and Duncan Middleton and Stuart Parks and Robert Shaw and Elaine Tang and Timothy Walsh and Alexander Weir and Elizabeth Wilson and Tara Quasim and Alasdair MacLullich and Zoe Tieges",
note = "OA article Acceptance from webpage Author not at GCU at time of pub Applied Gold exception as published in OA journal (immediate OA). ET 29/10/19",
year = "2018",
month = "9",
day = "17",
doi = "10.1186/s12877-018-0901-5",
language = "English",
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journal = "BMC Geriatrics",
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Rutter, L-M, Nouzova, E, Stott, D, Weir, CJ, Assi, V, Barnett, J, Clarke, C, Duncan, N, Evans, J, Green, S, Hendry, K, McGinlay, M, McKeever, J, Middleton, D, Parks, S, Shaw, R, Tang, E, Walsh, T, Weir, A, Wilson, E, Quasim, T, MacLullich, A & Tieges, Z 2018, 'Diagnostic test accuracy of a novel smartphone application for the assessment of attention deficits in delirium in older hospitalised patients: a prospective cohort study protocol', BMC Geriatrics, vol. 18, 217. https://doi.org/10.1186/s12877-018-0901-5

Diagnostic test accuracy of a novel smartphone application for the assessment of attention deficits in delirium in older hospitalised patients: a prospective cohort study protocol. / Rutter, Lisa-Marie; Nouzova, Eva; Stott, David; Weir, Christopher J.; Assi, Valentina; Barnett, Jennifer; Clarke, Caoimhe; Duncan, Nikki; Evans, Jonathan; Green, Samantha; Hendry, Kirsty; McGinlay, Meigan; McKeever, Jenny; Middleton, Duncan; Parks, Stuart; Shaw, Robert; Tang, Elaine; Walsh, Timothy; Weir, Alexander; Wilson, Elizabeth; Quasim, Tara; MacLullich, Alasdair; Tieges, Zoe.

In: BMC Geriatrics, Vol. 18, 217, 17.09.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Diagnostic test accuracy of a novel smartphone application for the assessment of attention deficits in delirium in older hospitalised patients: a prospective cohort study protocol

AU - Rutter, Lisa-Marie

AU - Nouzova, Eva

AU - Stott, David

AU - Weir, Christopher J.

AU - Assi, Valentina

AU - Barnett, Jennifer

AU - Clarke, Caoimhe

AU - Duncan, Nikki

AU - Evans, Jonathan

AU - Green, Samantha

AU - Hendry, Kirsty

AU - McGinlay, Meigan

AU - McKeever, Jenny

AU - Middleton, Duncan

AU - Parks, Stuart

AU - Shaw, Robert

AU - Tang, Elaine

AU - Walsh, Timothy

AU - Weir, Alexander

AU - Wilson, Elizabeth

AU - Quasim, Tara

AU - MacLullich, Alasdair

AU - Tieges, Zoe

N1 - OA article Acceptance from webpage Author not at GCU at time of pub Applied Gold exception as published in OA journal (immediate OA). ET 29/10/19

PY - 2018/9/17

Y1 - 2018/9/17

N2 - BACKGROUND:Delirium is a common and serious clinical syndrome which is often missed in routine clinical care. The core cognitive feature is inattention. We developed a novel bedside neuropsychological test for assessing inattention in delirium implemented on a smartphone platform (DelApp). We aim to evaluate the diagnostic performance of the DelApp in a representative cohort of older hospitalised patients.METHODS:This is a prospective study of older non-scheduled hospitalised patients (target n = 500, age ≥ 65), recruited from elderly care and acute orthopaedic wards. Exclusion criteria are: non-English speakers; severe vision or hearing impairment; photosensitive epilepsy. A structured reference standard delirium assessment based on DSM-5 criteria will be used, which includes a cognitive test battery administered by a trained assessor (Orientation-Memory-Concentration Test, Abbreviated Mental Test-10, Delirium Rating Severity Scale-Revised-98, digit span, months and days backwards, Vigilance A' test) and assessment of arousal (Observational Scale of Level of Arousal, Richmond Agitation Sedation Scale). Prior change in cognition will be documented using the Informant Questionnaire on Cognitive Decline in the Elderly. Patients will be categorized as delirium (with/without dementia), possible delirium, dementia, no cognitive impairment, or undetermined. A separate assessor (blinded to diagnosis and assessments) will administer the DelApp index test within 3 h of the reference standard assessment. The DelApp comprises assessment of arousal (score 0-4) and sustained attention (score 0-6), yielding a total score between 0 and 10 (higher score = better performance). Outcomes (length of stay, mortality and discharge location) will be collected at 12 weeks. We will evaluate a priori cutpoints derived from a previous case-control study. Measures of the accuracy of DelApp will include sensitivity, specificity, positive and negative predictive values, and area under the ROC curve. We plan repeat assessments on up to 4 occasions in a purposive subsample of 30 patients (15 delirium, 15 no delirium) to examine changes over time.DISCUSSION:This study evaluates the diagnostic test accuracy of a novel smartphone test for delirium in a representative cohort of older hospitalised patients, including those with dementia. DelApp has the potential to be a convenient, objective method of improving delirium assessment for older people in acute care.TRIAL REGISTRATION:Clinical trials.gov, NCT02590796 . Registered on 29 Oct 2015. Protocol version 5, dated 25 July 2016.

AB - BACKGROUND:Delirium is a common and serious clinical syndrome which is often missed in routine clinical care. The core cognitive feature is inattention. We developed a novel bedside neuropsychological test for assessing inattention in delirium implemented on a smartphone platform (DelApp). We aim to evaluate the diagnostic performance of the DelApp in a representative cohort of older hospitalised patients.METHODS:This is a prospective study of older non-scheduled hospitalised patients (target n = 500, age ≥ 65), recruited from elderly care and acute orthopaedic wards. Exclusion criteria are: non-English speakers; severe vision or hearing impairment; photosensitive epilepsy. A structured reference standard delirium assessment based on DSM-5 criteria will be used, which includes a cognitive test battery administered by a trained assessor (Orientation-Memory-Concentration Test, Abbreviated Mental Test-10, Delirium Rating Severity Scale-Revised-98, digit span, months and days backwards, Vigilance A' test) and assessment of arousal (Observational Scale of Level of Arousal, Richmond Agitation Sedation Scale). Prior change in cognition will be documented using the Informant Questionnaire on Cognitive Decline in the Elderly. Patients will be categorized as delirium (with/without dementia), possible delirium, dementia, no cognitive impairment, or undetermined. A separate assessor (blinded to diagnosis and assessments) will administer the DelApp index test within 3 h of the reference standard assessment. The DelApp comprises assessment of arousal (score 0-4) and sustained attention (score 0-6), yielding a total score between 0 and 10 (higher score = better performance). Outcomes (length of stay, mortality and discharge location) will be collected at 12 weeks. We will evaluate a priori cutpoints derived from a previous case-control study. Measures of the accuracy of DelApp will include sensitivity, specificity, positive and negative predictive values, and area under the ROC curve. We plan repeat assessments on up to 4 occasions in a purposive subsample of 30 patients (15 delirium, 15 no delirium) to examine changes over time.DISCUSSION:This study evaluates the diagnostic test accuracy of a novel smartphone test for delirium in a representative cohort of older hospitalised patients, including those with dementia. DelApp has the potential to be a convenient, objective method of improving delirium assessment for older people in acute care.TRIAL REGISTRATION:Clinical trials.gov, NCT02590796 . Registered on 29 Oct 2015. Protocol version 5, dated 25 July 2016.

U2 - 10.1186/s12877-018-0901-5

DO - 10.1186/s12877-018-0901-5

M3 - Article

VL - 18

JO - BMC Geriatrics

JF - BMC Geriatrics

SN - 1471-2318

M1 - 217

ER -