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Supported by the Centro de Investigacion para El Desarrollo y la Innovacion from the Universidad Pontificia Bolivariana, Medellin, Colombia.

Analysis of institutional authors

Franco, Jose GAuthorSepulveda, EstebanAuthor

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Validation of the Delirium Diagnostic Tool-Provisional (DDT-Pro) With Medical Inpatients and Comparison With the Confusion Assessment Method Algorithm

Publicated to:Journal Of Neuropsychiatry And Clinical Neurosciences. 32 (3): 213-226 - 2020-06-01 32(3), DOI: 10.1176/appi.neuropsych.18110255

Authors: Franco, Jose G; Ocampo, Maria V; Velasquez-Tirado, Juan D; Zaraza, Daniel R; Giraldo, Alejandra M; Serna, Paola A; Lopez, Carolina; Zuluaga, Adolfo; Sepulveda, Esteban; Kean, Jacob; Trzepacz, Paula T

Affiliations

Indiana Univ Sch Med, Dept Psychiat, Indianapolis, IN 46202 USA - Author
Univ Pontificia Bolivariana, Grp Invest Cuidado, Fac Enfermeria, Medellin, Colombia - Author
Univ Pontificia Bolivariana, Grp Invest Psiquiatria Enlace GIPE, Fac Med, Medellin, Colombia - Author
Univ Rovira & Virgili, Hosp Psiquiatr Univ Inst Pere Mata, IISPV, Ctr Invest Biomed Red Salud Mental CIBERSAM, Tarragona, Spain - Author
Univ Utah, Dept Commun Sci & Disorders, VA Salt Lake City Hlth Care Syst, Salt Lake City, UT USA - Author
Univ Utah, Dept Populat Hlth Sci, VA Salt Lake City Hlth Care Syst, Salt Lake City, UT USA - Author
Univ Utah, Hlth Syst Innovat & Res, Salt Lake City, UT USA - Author
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Abstract

Objective: Delirium remains underdetected as a result of its broad constellation of symptoms and the inadequate neuropsychiatric expertise of most medical-surgical clinicians. Brief, accurate tools are needed to enhance detection. Methods: The authors extended validation of the Delirium Diagnostic Tool-Provisional (DDT-Pro), originally validated in a study of inpatients with traumatic brain injury for diagnosis of delirium by nonexpert clinicians, for 200 general medical inpatients in Colombia. The three structured, quantitatively rated items in DDT-Pro represent the three core delirium domains. Results: High interrater reliability between physician and nurse (0.873) administrators, internal consistency (>0.81), and content validity were found. Compared with independent reference standard diagnosis with DSM-5 or the Delirium Rating Scale-Revised-98, the area under the receiver operating characteristic (ROC) curve (global diagnostic accuracy) range was 93.8%-96.3%. ROC analysis revealed the same cutoff score (<= 6) as that for the original study, with somewhat lower sensitivities of 88.0%-90.0% and specificities of 85.3%-81.2% (independent expert physician or nurse ratings). Even when rated by a trained expert physician, the original version of the Confusion Assessment Method algorithm (CAM-A) performed moderately, with lower sensitivities (61.8%-70.0%) than the DDT-Pro (88.0%- 100%) and somewhat higher specificities (84.8%-95.3% versus 67.4%286.7%), with values depending on dementia status, reference standard, and rater type. Accuracies for the DDT-Pro and CAM-A were comparable (DDT-Pro: 83.0%-87.5% versus CAM-A: 87.5%-88.5%), although lower in the dementia subgroup, especially for CAM-A. However, these tools were significantly discordant, especially in negative cases, which suggests that they do not detect diagnosis of patients in the same way. Conclusions: The DDT-Pro had high validity and reliability in provisional delirium diagnosis by physicians and nonexpert clinicians, although further validation is warranted before widespread use can be recommended.

Keywords

AdaptationAgedAged, 80 and overCareCognitive declineConsultation/liaison neuropsychiatryCriteriaCross-sectional studiesDeliriumDementiaFemaleHospital departmentsHumansInformant questionnaireInpatientsInternal medicineIqcodeMaleNursing assessmentPopulationProspective studiesPsychiatric status rating scalesRating-scale revised-98Reproducibility of resultsSensitivity and specificity

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Neuropsychiatry And Clinical Neurosciences due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2020, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Medicine (Miscellaneous).

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 4.9, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-19, the following number of citations:

  • WoS: 12
  • Scopus: 13
  • Europe PMC: 7
  • OpenCitations: 13

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-19:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 53.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 53 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 20.
  • The number of mentions on the social network X (formerly Twitter): 21 (Altmetric).
  • The number of mentions on Wikipedia: 1 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Colombia; India; United States of America.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (FRANCO VÁSQUEZ, JOSÉ GABRIEL) .