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A Pilot Study of "Stanford Proxy Test for Delirium" (S-PTD)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03954769
Recruitment Status : Completed
First Posted : May 17, 2019
Last Update Posted : May 17, 2019
Sponsor:
Information provided by (Responsible Party):
Jose R Maldonado, MD, Stanford University

Brief Summary:

Although there are several tools available for the screening of delirium among the medically ill, they all have some limitations. First, none of the available tools have been validated against newly developed and published DSM-5 (Diagnostic and Statistical Manual) or ICD-10 (International Statistical Classification of Diseases and Related Health Problems) criteria. Additionally, all the screening/diagnostic tools presently available have the same limitation, they all require significant patient involvement and participation (e.g., questions and activities) in order to complete the assessment. By definition, delirium is a neuropsychiatric disorder characterized by disturbance in attention and awareness, and additional disturbance in cognition (e.g., memory deficit, disorientation), language, visuospatial ability, or perception. The intrinsic characteristics of delirium seem to interfere with the patient's ability to participate and complete many of the tasks associated with delirium evaluation itself. Finally, most available tools seem to narrowly focus on some neurocognitive areas of delirium, but not being comprehensive enough.

In contrast, the S-PTD is designed so it can be completed by the nursing staff caring for the patients, the medical personnel most intimately involved with the care and aware of the behaviors exhibited by the patient during the course of their hospital stay. The idea is that nurses will complete the screening tool (hence the term "by proxy"), based on the behaviors and interactions observed during the course of a conventional "nursing shift", to determine whether the patient meets current neuropsychiatric criteria for the diagnosis of delirium.


Condition or disease
Hyperactive Delirium Hypoactive Delirium Mixed Type Delirium

Detailed Description:

Patients admitted to Stanford Hospital and Clinics medical and surgical units meeting the study's inclusion and exclusion criteria will be considered for enrollment during the recruitment phase.

The research personnel, under the supervision of the study PI (an expert in delirium), will perform daily study procedures as follows:

A member of the research team will obtain a list of all newly admitted patients from the prior 24 hours each Monday through Friday morning from the unit's nurse manager. A member of the research team will also look at daily operating room schedules for patients to be admitted to participating units post-operatively, having received permission to do so from the directors of participating medical/surgical services. Given that the purpose of this tool is to screen for a condition that may occur in medically ill patients, every newly admitted patient or their surrogate (for those lacking decisional making capacity), meeting inclusion criteria will be approached for participation in the study and asked to provide consent. Patients lacking capacity for consent will not be automatically excluded, given that the inclusion of delirious patients is critical for adequate evaluation of the S-PTD, and most delirious patients, by definition, lack capacity to provide informed consent. We will ask for the consent from surrogate decision makers in these cases.

In addition, it is anticipated that some patients who meet eligibility will be unable to sign a consent form due to physical limitations related to their hospitalization (e.g. patients recovering from recent surgery). If a patient is unable to sign the consent form due to physical limitations, oral consent will be obtained. Oral consent will also be used in the event that a patient lacks capacity and has no surrogate decision-maker at bedside, but a surrogate decision-maker is available by phone. For Spanish-speaking patients, consent will be obtained by the same procedures utilizing Spanish-language written/oral consent, with the help of SHC interpreter services.

For each patient that consents to participate in the study, the nurse assigned to that patient during the shift will be approached. These nurses will additionally be asked to provide consent, as they are also subjects of the study.

All patients will be followed for the duration of their hospital stay (expected to average 5 days), to a maximum of two weeks, except in the case of delirious patients, who will be followed until the resolution of the episode of delirium.

Every day, enrolled patients will undergo two, separate evaluations. Towards the end of their shift (within the last 2-hrs of each shift) the patient's nurse will complete the S-PTD, utilizing all available data from the entire nursing shift (8-12 hours, depending the unit's shift mode), which allows nurses to take into account all of nurse's interactions and observations across the entire shift (including direct interactions between the patient and the nurse, family and all clinical staff). In addition, patients will undergo a clinical neuropsychiatric examination performed by a neuropsychiatrist (the gold standard), estimated to take about 5 minutes. The examiners will be blind to the results of each other's exam. Finally, a member of the research team, blind to the results of the previous tests, will conduct a separate interview of the patient's nurse towards the end of the shift in order collect the nurse's forms and evaluate the nurse's opinions regarding the ease to complete the S-PTD.

Later the results of the S-PTD will be compared against the results of the neuropsychiatric examination. The sensitivity, specificity, positive predictive value, and negative predictive value of the S-PTD will be calculated as compared to the results of clinical neuropsychiatric evaluation based on DSM-5 criteria.

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Study Type : Observational
Actual Enrollment : 300 participants
Observational Model: Case-Only
Time Perspective: Prospective
Official Title: A Pilot Study of the Psychometric Properties of the "Stanford Proxy Test for Delirium" (S-PTD): a New Screening Tool for the Detection of Delirium
Actual Study Start Date : February 2014
Actual Primary Completion Date : January 2016
Actual Study Completion Date : May 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Delirium

Group/Cohort
Inpatients
Patients admitted to Stanford Hospital and Clinics medical and surgical units



Primary Outcome Measures :
  1. Incidence of delirium [ Time Frame: The study will be carried out over a 2-year period; patients will be followed throughout the hospital stay, for a maximum of 2-weeks from the time of admission, or until discharge. ]
    Every day, enrolled patients will undergo two evaluations: (1) At the end of the nursing shift, nurses will complete the S-PTD based on the entirety of the interactions with the patient throughout the course of their shift, estimated to take about 2-3 minutes; (2) then, within 1-hour of the nurse's S-PTD assessment a member of the Psychosomatic Medicine Service will conduct a blinded clinical neuropsychiatric examination (the gold standard for delirium diagnosis). At the end of their nursing shift (either 8 or 12 hours).



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Patients admitted to selected Stanford Hospital and Clinics general medical/surgical units, for any diagnosis. Both female and male patients, English or Spanish-speaking subjects, age 18 and above, of any ethnic background will be recruited.
Criteria

Inclusion Criteria:

  • Inclusion criteria for enrolled patients:

    • all inpatients admitted to Stanford Hospital's selected general medical and surgical units
    • patients must be able to communicate and read English and/or Spanish
    • ages 18 and older
  • Inclusion criteria for enrolled nurses:

    • All nurses assigned to each enrolled patient for the shift during which that patient is enrolled, will be invited to participate in the study to assess the tool's acceptability and ease of use.

Exclusion Criteria:

  • For enrolled patients:

    • unable to speak English or Spanish.
    • unwillingness to participate in the study
    • for patients who are unable to consent (i.e., lack capacity), either the lack of availability of a suitable surrogate or the surrogate's unwillingness to provide consent
  • For enrolled nurses: unwillingness to participate in the study.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03954769


Locations
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United States, California
Stanford Hospital and Clinics
Stanford, California, United States, 94305
Sponsors and Collaborators
Stanford University
Investigators
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Principal Investigator: Jose R Maldonado, M.D. Stanford University

Publications:
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Responsible Party: Jose R Maldonado, MD, Associate Professor, Stanford University
ClinicalTrials.gov Identifier: NCT03954769    
Other Study ID Numbers: 28327
First Posted: May 17, 2019    Key Record Dates
Last Update Posted: May 17, 2019
Last Verified: April 2019
Keywords provided by Jose R Maldonado, MD, Stanford University:
Delirium,
Confusion Assessment Method
Proxy Test of Delirium
DSM-V
Hyperactive Delirium
Hypoactive Delirium
Mixed-type delirium
Additional relevant MeSH terms:
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Delirium
Hypokinesia
Hyperkinesis
Confusion
Neurobehavioral Manifestations
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Neurocognitive Disorders
Mental Disorders
Dyskinesias