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3-item DSD: Three-item Delirium Superimposed on Dementia screener

2019

A candidate three-item screen for delirium superimposed on dementia, derived from patient responses and observed sleepiness in a secondary analysis. It requires prospective validation before routine clinical adoption.

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Original paper

  • Principal sourceSteensma E, Zhou W, Ngo L, Gallagher J, Inouye S, Leslie D, et al. Ultra-brief Screeners for Detecting Delirium Superimposed on Dementia. Journal of the American Medical Directors Association. 2019;20(11):1391-1396.e1. doi: 10.1016/j.jamda.2019.05.011. PMID: 31279670.

    This is the principal published source for 3-item DSD. It reported sensitivity of 94% and specificity of 42% against CAM criteria.

One DTA study identifiedEmerging clinical record

At a glance

Purpose
Episodic assessment
Population
Adult
Setting
General / acute hospital
Time
ultra-brief; formal timing not reported in the derivation study
Items
3
Score or threshold
Positive if any of the three candidate components is positive in the derivation analysis

Format: The proposed screen combines days of the week backwards, orientation to the type of place and observed sleepiness. Any error on the two patient tasks, failure to respond, or observed sleepiness counted as a positive screen in the derivation analysis. Formal administration time was not reported.

  • Strengths: High sensitivity in a large dementia cohort; combines cognitive responses with a brief observation
  • Limitations: Candidate selected and evaluated in the same secondary dataset; low specificity; no independent prospective validation

Evidence

Evidence maturityOne DTA study identified

Reported sensitivity and specificity

Headline metric source

Original/source study · 2019 — pmid:31279670

Denominator
Reported source unit: 391 (analysis unit not fully reconciled)
Reference standard
CAM criteria
94%
Sensitivity
42%
Specificity

Top three-item combination in the first-day END-DSD secondary analysis (n=391); candidate selection and accuracy estimation used the same dataset.

More evidence and citation details
Full name
Three-item Delirium Superimposed on Dementia screener
Also known as
3-item DSD, three-item DSD screener
Evidence summary
derivation-only
Diagnostic-accuracy studies
1
Reference standard
CAM criteria
Citation
Steensma E, Zhou W, Ngo L, Gallagher J, Inouye S, Leslie D, Boltz M, Kolanowski A, Mion L, Marcantonio ER, Fick D Ultra-brief Screeners for Detecting Delirium Superimposed on Dementia Journal of the American Medical Directors Association. 2019;20(11):1391-1396.e1. PMID 31279670
Copyright and reuse
Information checked
2026-07-19

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Sources checked 2026-07-29. How profiles are prepared.