Concordance between DSM-IV and DSM-5 criteria for delirium diagnosis in a pooled database of 768 prospectively evaluated patients using the delirium rating scale-revised-98

David J. Meagher, Alessandro Morandi, Sharon K. Inouye, Wes Ely, Dimitrios Adamis, Alasdair J. Maclullich, James L. Rudolph, Karin Jane Neufeld, Maeve Leonard, Giuseppe Bellelli, Daniel Davis, Andrew Teodorczuk, Stefan Kreisel, Christine Thomas, Wolfgang Hasemann, Suzanne Timmons, Niamh O'Regan, Sandeep Grover, Faiza Jabbar, Walter CullenColum Dunne, Barbara Kamholz, Barbara C. Van Munster, Sophia E. De Rooij, Jos De Jonghe, Paula T. Trzepacz

Research output: Contribution to journalArticle


BACKGROUND: The Diagnostic and Statistical Manual fifth edition (DSM-5) provides new criteria for delirium diagnosis. We examined delirium diagnosis using these new criteria compared with the Diagnostic and Statistical Manual fourth edition (DSM-IV) in a large dataset of patients assessed for delirium and related presentations.

METHODS: Patient data (n = 768) from six prospectively collected cohorts, clinically assessed using DSM-IV and the Delirium Rating Scale-Revised-98 (DRS-R98), were pooled. Post hoc application of DRS-R98 item scores were used to rate DSM-5 criteria. 'Strict' and 'relaxed' DSM-5 criteria to ascertain delirium were compared to rates determined by DSM-IV.

RESULTS: Using DSM-IV by clinical assessment, delirium was found in 510/768 patients (66%). Strict DSM-5 criteria categorized 158 as delirious including 155 (30%) with DSM-IV delirium, whereas relaxed DSM-5 criteria identified 466 as delirious, including 455 (89%) diagnosed by DSM-IV (P

CONCLUSIONS: The concordance between DSM-IV and the new DSM-5 delirium criteria varies considerably depending on the interpretation of criteria. Overly-strict adherence for some new text details in DSM-5 criteria would reduce the number of delirium cases diagnosed; however, a more 'relaxed' approach renders DSM-5 criteria comparable to DSM-IV with minimal impact on their actual application and is thus recommended.

Original languageEnglish (US)
Pages (from-to)164
Number of pages1
JournalBMC Medicine
Publication statusPublished - 2014


ASJC Scopus subject areas

  • Medicine(all)

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