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DTS: Delirium Triage Screen

2013

The Delirium Triage Screen is a two-part, ultra-brief emergency-department high-sensitivity first-step screen covering arousal and attention. It is commonly paired with a more-specific follow-up assessment; a negative result does not exclude delirium or overrule clinical concern.

At a glance

Purpose
Episodic assessment
Population
Adult
Setting
Emergency department
Time
<20 sec
Items
2
Score or threshold
Altered LOC or ≥2 errors on 'LUNCH' backwards

Format: The instrument records 2 scored items or observations. This site classifies it under episodic assessment and ultra-brief bedside tools. It is intended for adult use in Emergency department. The stated administration time is <20 sec. The published result is recorded using Altered LOC or ≥2 errors on 'LUNCH' backwards.

  • Strengths: Ultra-brief, high-sensitivity first step
  • Limitations: Low specificity by design; pair with bCAM; a negative result does not exclude delirium or overrule clinical concern

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

None identified in the scoped review.

None identified in the selected profile sources and the Penfold general-hospital review. This is not a completed search of all settings or later papers.

Training and instructions

  • DTS training manual. Public ICU Delirium resource directory. Open the resource with this tool’s name; versions are listed separately.
  • DTS form. Public instrument material checked on 5 September 2026. Follow the source’s version and permission conditions.
  • DTS manual or instructions. Public manual or instructions checked on 5 September 2026. Follow the source’s version and permission conditions.
Start here

Tool and original sources

A source for the tool or its access information is linked below. Check the version and current terms before use, copying or adaptation.

View the tool ↗ Official information and permissions ↗

Original paper

  • Original paperHan JH, Wilson A, Vasilevskis EE, Shintani A, Schnelle JF, Dittus RS, et al. Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method. Annals of emergency medicine. 2013;62(5):457-465. doi: 10.1016/j.annemergmed.2013.05.003. PMID: 23916018.

    This paper reports the original validation of DTS. It is the main source for the method, its intended use and the evidence available at publication.

    Open PubMed ↗
One DTA study identifiedCore instrument family
Classification

Classification

Episodic assessmentUltra-brief bedside tools

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

98%
Sensitivity
~55%
Specificity

Original validation, n=406; evaluated as a high-sensitivity first step.

Expanded evidence profile

What the broader evidence shows

Interpretation: DTS is a very brief, deliberately high-sensitivity first-stage screen intended to rule out delirium before a more specific assessment such as bCAM. Its standalone evidence still rests chiefly on one single-centre cohort; a positive DTS is not diagnostic, and the sparse literature should be stated rather than obscured by unrelated papers.

Evidence snapshots

  • Original emergency-department study (2013): In 406 adults aged 65 years or older, DTS sensitivity was 98% and specificity about 55% against a psychiatrist DSM-IV-TR assessment.
  • Emergency-department review (2016): A systematic review described DTS as the high-sensitivity first stage of a two-step DTS-bCAM strategy, but found no substantial independent replication.
  • Later validation report (2021): A small study assessed the combined DTS-bCAM workflow across 76 assessments in 29 patients, with only two positive cases; it does not validate DTS alone.
  • Diagnostic meta-analysis (2024): The review judged DTS the strongest rule-out instrument in the emergency department, explicitly on the basis of the original single-centre study.

These results come from different populations and workflows and should not be averaged or treated as interchangeable.

4 selected PubMed-indexed papers, 2013–2024
  1. 2013Original validation study
    Han JH, Wilson A, Vasilevskis EE, Shintani A, Schnelle JF, Dittus RS, et al. Diagnosing delirium in older emergency department patients: validity and reliability of the Delirium Triage Screen and the Brief Confusion Assessment Method. Ann Emerg Med. 2013;62(5):457-465. doi: 10.1016/j.annemergmed.2013.05.003. PMID: 23916018.

    This academic emergency-department study enrolled 406 adults aged 65 years or older and used a psychiatrist DSM-IV-TR assessment performed within three hours as the reference standard. DTS sensitivity was 98% and specificity about 55%, supporting its intended role as a first-stage rule-out screen before the more specific bCAM.

    PubMed · PMID 23916018 ↗
  2. 2016Systematic review
    Mariz J, Costa Castanho T, Teixeira J, Sousa N, Correia Santos N. Delirium Diagnostic and Screening Instruments in the Emergency Department: An Up-to-Date Systematic Review. Geriatrics (Basel). 2016;1(3):22. doi: 10.3390/geriatrics1030022. PMID: 31022815.

    This systematic review searched emergency-department delirium instruments through November 2015 and included seven tools. It treated DTS and bCAM as distinct stages of a strategy but showed that the DTS accuracy evidence still rested largely on the original cohort.

    PubMed · PMID 31022815 ↗
  3. 2021Small combined-workflow validation study
    Sederstrom JR, Aliory CD, Hanneman EM, Buras MR. Delirium Triage Screen/Brief Confusion Assessment Method in Adult Orthopaedic and Hematological Patients: A Validation Study. Orthop Nurs. 2021;40(1):16-22. doi: 10.1097/NOR.0000000000000726. PMID: 33492905.

    This study evaluated a combined DTS-bCAM workflow against a researcher-applied CAM across 76 assessments in 29 orthopaedic and haematology patients. Only two assessments were positive, so the reported perfect sensitivity and specificity have extremely wide uncertainty and do not constitute a standalone DTS validation.

    PubMed · PMID 33492905 ↗
  4. 2024Diagnostic-accuracy meta-analysis
    Carpenter CR, Lee S, Kennedy M, Arendts G, Schnitker L, Eagles D, et al. Delirium detection in the emergency department: A diagnostic accuracy meta-analysis of history, physical examination, laboratory tests, and screening instruments. Acad Emerg Med. 2024;31(10):1014-1036. doi: 10.1111/acem.14935. PMID: 38757369.

    This diagnostic meta-analysis synthesised 27 emergency-department studies of history, examination and screening instruments. It identified DTS as the most useful rule-out screen, but that conclusion was explicitly based on one single-centre study, confirming that the standalone evidence remains thin.

    PubMed · PMID 38757369 ↗

This is a selected evidence overview, not a systematic review. Only four papers are included because the standalone DTS evidence is sparse; all four records were checked in PubMed, with citation-network screening in OpenAlex and integrity checks in Scite, on 31 August 2026.

More evidence and citation details
Full name
Delirium Triage Screen
Related profiles
bCAM, DTS/bCAM combination
Evidence summary
single
Diagnostic-accuracy evaluations
1
Reference standard
DSM-IV-TR (psychiatrist)
Reliability
;
Citation
Han JH, Wilson A, Vasilevskis EE, Shintani A, Schnelle JF, Dittus RS, Graves AJ, Storrow AB, Shuster J, Ely EW Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method Annals of emergency medicine. 2013;62(5):457-465. PMID 23916018
Download RIS ↗ Download BibTeX ↗

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. Han JH, Wilson A, Vasilevskis EE, Shintani A, Schnelle JF, Dittus RS, Graves AJ, Storrow AB, Shuster J, Ely EW (2013). Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method. Annals of emergency medicine.

    Reference category: independent clinical reference.

Copyright and reuse
Version
18 January 2021 revision
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.