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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.

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

CAM usually means the four-feature short form; the long form has ten items. Check which form and supporting assessment the study used. Short and long CAM explained.

Primary validation papers

1 identified diagnostic-accuracy paper

Other forms of validation are described in the evidence section. What is counted?

Large-scale clinical implementation

Not yet reviewed.

A focused implementation review has not yet been completed for this profile.

Training and instructions

Public training resources have not yet been confirmed in this review. Check the linked developer or original source for instructions.

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Tool and original sources

No direct copy is linked here. The original paper and a Google Images search are available below. Image results may be unofficial; check the version and source before use.

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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.

    Open PubMed ↗
One DTA study identifiedEmerging clinical record
Classification

Classification

Episodic assessmentCognitive tests designed for delirium

A tool may belong to more than one category. Select a linked category to see other relevant profiles.

Evidence

Diagnostic-accuracy evidenceOne 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 evaluations
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
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Primary validation studies

Distinct primary publications from the current diagnostic-accuracy audit. Reviews and repeated evaluations within one paper are not counted again. Overlapping cohorts have not all been reconciled. Read the counting rules and limitations.

Open 1 identified paper
  1. Steensma E, Zhou W, Ngo L, Gallagher J, Inouye S, Leslie D, Boltz M, Kolanowski A, Mion L, Marcantonio ER, Fick D (2019). Ultra-brief Screeners for Detecting Delirium Superimposed on Dementia. Journal of the American Medical Directors Association.

    Reference category: other comparator or secondary accuracy evidence.

Copyright and reuse
Information checked
2026-07-19

Instrument-specific terms apply. See the access and copyright policy or send a correction.

Base clinical review: 2026-07-29. Instrument description source check: 2026-09-05. Scope and limitations.