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Content validity, practicality and testing of the reliability of various tools for the detection and screening of delirium in residents with dementia in German nursing homes: a study protocol
Johanna Christina Seiters, Vincent Molitor, Alessandro Morandi, Tania Zieschang, Martin Dichter, Burkhard Haastert, Maria Erdmann, Falk Hoffmann et al.. BMJ Open, 2025-12-01
Topic: Risk, prevention and care in population studies
INTRODUCTION: Although individuals with dementia who reside in nursing homes are particularly susceptible to developing delirium, this condition is rarely recognised in these settings. Detection of delirium requires validated and reliable tools for this setting that can be applied by nursing staff. The primary objective of the study is to assess the comprehensibility, practicality and inter-rater reliability of two delirium detection tools (4 A's test (4AT) and 4-item delirium superimposed on dementia (4-DSD)) and one tool for assessing both the diagnosis and severity of delirium (Delirium Rating Scale-Revised-98 (DRS-R-98)) in people with dementia who reside in nursing homes when used by nurses. METHODS AND ANALYSIS: The comprehensibility and practicality of the German versions of the 4AT, 4-DSD and DRS-R-98 will be evaluated using cognitive interviews in accordance with the consensus-based standards for the selection of health measurement instruments framework. On the basis of the results of the cognitive interviews, a manual for each of the three tools will be developed and finalised by an expert panel. Finally, the inter-rater reliability and measurement error of the three tools will be determined using the manuals. For this purpose, a total of 70 residents from six nursing homes will be assessed by at least two nurses. The data analysis will include descriptive statistics and inter-rater reliability assessment for individual items (kappa value) and total scores (Intraclass correlation coefficients). ETHICS AND DISSEMINATION: This study will assess the comprehensibility, practicality and inter-rater reliability of the 4AT, 4-DSD and DRS-R-98 for use in residents with dementia in nursing homes. The project was approved by the medical ethics committee of the University of Oldenburg (reference number: 2025-093). TRIAL REGISTRATION NUMBER: The inter-rater reliability study was registered in the German Clinical Trials Register. REGISTRATION NUMBER: DRKS00037458 (https://www.drks.de/search/de/trial/DRKS00037458/details).
Key findings
- On the basis of the results of the cognitive interviews, a manual for each of the three tools will be developed and finalised by an expert panel.
Why it matters
This study protocol describes a planned assessment of the comprehensibility, practicality and inter-rater reliability of three delirium detection tools when used by nurses in German nursing homes. It aims to develop manuals for the tools and test them with 70 residents assessed by at least two nurses.
Study details
- Participants70
- Evidence strengthLow
How this study scored 38/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (BMJ Open) |
| Journal's citation record | 2 / 4 | BMJ Open: journal h-index 240 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 1 / 4 | 70 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 1 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 1 / 6 | Cited 0.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 1 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Rebecca Palm: h-index 18 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Cologne: institution h-index 879 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 3 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41448697) |
| Free to read | 2 / 2 | Free to read |
| Total | 38 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Seiters, J. C., Molitor, V., Morandi, A., Zieschang, T., Dichter, M., Haastert, B., et al. (2025). Content validity, practicality and testing of the reliability of various tools for the detection and screening of delirium in residents with dementia in German nursing homes: a study protocol. BMJ Open. https://doi.org/10.1136/bmjopen-2025-112357
Vancouver
Seiters JC, Molitor V, Morandi A, Zieschang T, Dichter M, Haastert B, et al. Content validity, practicality and testing of the reliability of various tools for the detection and screening of delirium in residents with dementia in German nursing homes: a study protocol. BMJ Open. 2025. doi:10.1136/bmjopen-2025-112357. PMID: 41448697.
BibTeX
@article{seiters2025-41448697,
author = {Seiters, Johanna Christina and Molitor, Vincent and Morandi, Alessandro and Zieschang, Tania and Dichter, Martin and Haastert, Burkhard and Erdmann, Maria and Hoffmann, Falk and others},
title = {{Content validity, practicality and testing of the reliability of various tools for the detection and screening of delirium in residents with dementia in German nursing homes: a study protocol}},
journal = {BMJ Open},
year = {2025},
doi = {10.1136/bmjopen-2025-112357},
pmid = {41448697},
url = {https://doi.org/10.1136/bmjopen-2025-112357}
}
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