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NuDESC: Nursing Delirium Screening Scale

2005

Observational five-item scale designed for fast, repeated screening by bedside nurses across a shift.

At a glance

Purpose
Episodic assessment
Population
Adult
Setting
General / acute hospital, Palliative care, Perioperative
Time
~1 min
Items
5
Score or threshold
≥2 of 10

Format: Usually laid out as a compact five-row nursing observation scale. Each row records the severity of a behaviour observed during the shift, followed by a summed score and threshold. It is designed for repeated use rather than a full cognitive assessment at every administration.

  • Strengths: Very brief; repeatable nurse-led observation across a shift; often high specificity
  • Limitations: Sensitivity varies substantially by setting and threshold. At 2 or more, false negatives can be common, so a negative score does not rule out delirium.

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

24 identified diagnostic-accuracy papers

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

Large-scale clinical implementation

Reports identified: read the commentary

Selected primary reports and Penfold et al. (2024); not a completed census.

Training and instructions

Start here

Tool and original sources

View the NuDESC in Figure 1 of the original article. The figure is not reproduced here.

View the tool in the paper ↗ Search Google Images ↗ NIDUS information cards ↗

Original and selected diagnostic-accuracy papers

  • Original paperGaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. Journal of pain and symptom management. 2005;29(4):368-75. doi: 10.1016/j.jpainsymman.2004.07.009. PMID: 15857740.

    This is the original published source for NuDESC. It reported sensitivity of 85.7% and specificity of 86.8% against CAM assessment by trained research nurse or psychiatrist; reference assessor blinded to Nu-DESC.

    Open PubMed ↗
  • Selected diagnostic-accuracy studyLuetz A, Heymann A, Radtke FM, Chenitir C, Neuhaus U, Nachtigall I, et al. Different assessment tools for intensive care unit delirium: which score to use?. Critical care medicine. 2010;38(2):409-18. doi: 10.1097/CCM.0b013e3181cabb42. PMID: 20029345.

    This diagnostic-accuracy study evaluated NuDESC in university-hospital ICU against an independent DSM-IV clinical assessment. It reported sensitivity of 83% and specificity of 81% in 156 surgical ICU patients aged 60 years or older.

    Open PubMed ↗
  • Selected diagnostic-accuracy studyRadtke FM, Franck M, Schneider M, Luetz A, Seeling M, Heinz A, et al. Comparison of three scores to screen for delirium in the recovery room. British journal of anaesthesia. 2008;101(3):338-43. doi: 10.1093/bja/aen193. PMID: 18603528.

    This diagnostic-accuracy study evaluated NuDESC in post-anaesthesia recovery room against a DSM-IV clinical assessment. It reported sensitivity of 95% and specificity of 87% in 154 adult postoperative patients.

    Open PubMed ↗
Pooled diagnostic-accuracy evidenceCore instrument family
Classification

Classification

Episodic assessmentMonitoring for new onset delirium

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

Evidence

Diagnostic-accuracy evidencePooled diagnostic-accuracy evidence

Reported sensitivity and specificity

Headline metric source

Original/source study · 2005; pmid:15857740

Denominator
59 paired assessments
Reference standard
CAM assessment by trained research nurse or psychiatrist; reference assessor blinded to Nu-DESC
85.7%
Sensitivity
86.8%
Specificity

Original study estimate from 59 blinded paired ratings within 146 screened admissions; later studies and pooled estimates are shown below.

Expanded evidence profile

What the broader evidence shows

Interpretation: Across systematic reviews, Nu-DESC is usually more specific than sensitive. At the conventional threshold of 2 or more, sensitivity varies substantially by setting; a negative score does not rule out delirium, and a positive score requires clinical assessment.

Evidence snapshots

  • Nu-DESC-specific review (2020): 11 studies and 2,245 patients: pooled sensitivity 68.6%, specificity 89.4% and HSROC area 0.88.
  • Older-adult review (2023): 38 studies overall: pooled Nu-DESC sensitivity 0.78 and specificity 0.90.
  • Postoperative review (2025): 10 Nu-DESC reports and 1,950 patients: pooled sensitivity 0.69 and specificity 0.99.

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

8 selected PubMed-indexed papers, 2005–2025
  1. 2005Original validation study
    Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage. 2005;29(4):368-375. doi: 10.1016/j.jpainsymman.2004.07.009. PMID: 15857740.

    This original study developed the five-item Nu-DESC and compared 59 blinded paired ratings within a cohort of 146 hospital admissions with CAM assessments. At the threshold of 2 or more it reported 85.7% sensitivity and 86.8% specificity, but the selected paired-assessment subset and oncology setting limit generalisability.

    PubMed · PMID 15857740 ↗
  2. 2013Diagnostic-accuracy study
    Neufeld KJ, Leoutsakos JS, Sieber FE, Joshi D, Wanamaker BL, Rios-Robles J, et al. Evaluation of two delirium screening tools for detecting post-operative delirium in the elderly. Br J Anaesth. 2013;111(4):612-618. doi: 10.1093/bja/aet167. PMID: 23657522.

    This postoperative study compared Nu-DESC with a DSM-IV neuropsychiatric assessment in 91 adults aged 70 years or older. At 2 or more sensitivity was only 32% in recovery and 29% across repeated assessments, while specificity remained above 90%; lowering the threshold to 1 or more improved sensitivity but reduced specificity.

    PubMed · PMID 23657522 ↗
  3. 2017Diagnostic-accuracy study
    Hargrave A, Bastiaens J, Bourgeois JA, Neuhaus J, Josephson SA, Chinn J, et al. Validation of a Nurse-Based Delirium-Screening Tool for Hospitalized Patients. Psychosomatics. 2017;58(6):594-603. doi: 10.1016/j.psym.2017.05.005. PMID: 28750835.

    This hospital-wide nurse-based study compared Nu-DESC with physician-applied DSM-5 criteria in 405 consecutive inpatients. At 2 or more sensitivity was 42% and specificity 98%; at 1 or more they were 67% and 93%, reinforcing the threshold trade-off.

    PubMed · PMID 28750835 ↗
  4. 2020Systematic review and meta-analysis
    Jeong E, Park J, Lee J. Diagnostic test accuracy of the Nursing Delirium Screening Scale: A systematic review and meta-analysis. J Adv Nurs. 2020;76(10):2510-2521. doi: 10.1111/jan.14482. PMID: 32869373.

    This Nu-DESC-specific diagnostic-accuracy review included 11 studies and 2,245 patients. Pooled sensitivity was 68.6%, specificity 89.4% and HSROC area 0.88, with substantial heterogeneity relevant to interpretation.

    PubMed · PMID 32869373 ↗
  5. 2021Diagnostic-accuracy study
    Fleischmann R, Warwas S, Andrasch T, Kunz R, Witt C, Mengel A, et al. Course and Recognition of Poststroke Delirium: A Prospective Noninferiority Trial of Delirium Screening Tools. Stroke. 2021;52(2):471-478. doi: 10.1161/STROKEAHA.120.031019. PMID: 33380165.

    This prospective stroke and transient-ischaemic-attack cohort evaluated twice-daily Nu-DESC screening against DSM-5 in 141 patients. Patient-level Nu-DESC sensitivity was 93% and specificity 66%, illustrating a different false-positive profile where focal neurological deficits can confound screening.

    PubMed · PMID 33380165 ↗
  6. 2022Diagnostic-accuracy study
    Somnuke P, Limprapassorn P, Srinonprasert V, Wongviriyawong T, Suraarunsumrit P, Morkphrom E, et al. The Thai version of the nursing delirium screening scale-Thai: Adaptation and validation study in postoperative patients. Front Med (Lausanne). 2022;9:956435. doi: 10.3389/fmed.2022.956435. PMID: 36213680.

    This postoperative study evaluated a Thai translation in 70 older adults with 140 assessments against geriatrician DSM-5 diagnosis. At 2 or more sensitivity was 55% and specificity 90.8%; at 1 or more sensitivity rose to 85% and specificity fell to 71.7%.

    PubMed · PMID 36213680 ↗
  7. 2023Systematic review and meta-analysis
    Lin CJ, Su IC, Huang SW, Chen PY, Traynor V, Chang HCR, et al. Delirium assessment tools among hospitalized older adults: A systematic review and metaanalysis of diagnostic accuracy. Ageing Res Rev. 2023;90:102025. doi: 10.1016/j.arr.2023.102025. PMID: 37527704.

    This review compared 4AT, Nu-DESC and CAM against DSM or ICD criteria in 38 studies and 7,378 patients. For Nu-DESC, pooled sensitivity was 0.78 and specificity 0.90; results varied with setting, sample and assessor.

    PubMed · PMID 37527704 ↗
  8. 2025Systematic review and meta-analysis
    Lin CJ, Fick DM, Traynor V, Chen YC, Hsiang HF, Chiu HY. Comparative Diagnostic Accuracy of Nursing Delirium Screening Scale Versus Confusion Assessment Method for Postoperative Delirium: A Systematic Review and Meta-Analysis. J Clin Nurs. 2025;34(1):287-298. doi: 10.1111/jocn.17467. PMID: 39334567.

    This postoperative diagnostic meta-analysis included 10 Nu-DESC reports comprising 1,950 patients. Pooled sensitivity was 0.69 and specificity 0.99, leading the authors to judge sensitivity suboptimal despite high specificity.

    PubMed · PMID 39334567 ↗

This is a selected evidence overview, not a systematic review. Papers were prioritised for recency, methodological relevance, range of clinical settings and journal standing; all eight records were checked in PubMed on 30 August 2026.

More evidence and citation details
Full name
Nursing Delirium Screening Scale
Also known as
Nu-DESC
Related profiles
Korean Nu-DESC, Modified Nu-DESC
Evidence summary
Systematic reviews and multiple diagnostic-accuracy studies
Diagnostic-accuracy evaluations
24
Reference standard
CAM / DSM-IV
Source-study sample
146 patients; 59 assessments; 2005 · pmid:15857740; 146 patients screened; 59 blinded paired ratings in the accuracy analysis
Reliability
;
Real-world use
Inpatient positive-score rates 5–13%, often below expected delirium prevalence. (Penfold 2024)
Citation
Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale Journal of pain and symptom management. 2005;29(4):368-75. PMID 15857740
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 24 identified papers
  1. Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA (2005). Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. Journal of pain and symptom management.

    Reference category: other comparator or secondary accuracy evidence.

  2. Leung Jl, Leung Vc, Leung CM, Pan PC (2008). Clinical utility and validation of two instruments (the Confusion Assessment Method Algorithm and the Chinese version of Nursing Delirium Screening Scale) to detect delirium in geriatric inpatients. General hospital psychiatry.

    Reference category: independent clinical reference.

  3. Radtke FM, Franck M, Schneider M, Luetz A, Seeling M, Heinz A, Wernecke KD, Spies CD (2008). Comparison of three scores to screen for delirium in the recovery room. British journal of anaesthesia.

    Reference category: other comparator or secondary accuracy evidence.

  4. Luetz A, Heymann A, Radtke FM, Chenitir C, Neuhaus U, Nachtigall I, von Dossow V, Marz S, Eggers V, Heinz A, Wernecke KD, Spies CD (2010). Different assessment tools for intensive care unit delirium: which score to use?. Critical care medicine.

    Reference category: independent clinical reference.

  5. Radtke FM, Franck M, Schust S, Boehme L, Pascher A, Bail HJ, Seeling M, Luetz A, Wernecke KD, Heinz A, Spies CD (2010). A comparison of three scores to screen for delirium on the surgical ward. World journal of surgery.

    Reference category: other comparator or secondary accuracy evidence.

  6. Neufeld KJ, Leoutsakos JS, Sieber FE, Joshi D, Wanamaker BL, Rios-Robles J, Needham DM (2013). Evaluation of two delirium screening tools for detecting post-operative delirium in the elderly. British journal of anaesthesia.

    Reference category: independent clinical reference.

  7. Lingehall HC, Smulter N, Engström KG, Gustafson Y, Olofsson B (2013). Validation of the Swedish version of the Nursing Delirium Screening Scale used in patients 70 years and older undergoing cardiac surgery. Journal of clinical nursing.

    Reference category: other comparator or secondary accuracy evidence.

  8. Abelha F, Veiga D, Norton M, Santos C, Gaudreau JD (2013). Delirium assessment in postoperative patients: Validation of the Portuguese version of the Nursing Delirium Screening Scale in critical care. Brazilian journal of anesthesiology (Elsevier).

    Reference category: other comparator or secondary accuracy evidence.

  9. Su-Jung Kim, Jun-Ah Song (2015). Evaluation of Clinical Usefulness of Delirium Assessment Tools for Elderly Patients after Neurosurgery. Journal of Korean Gerontological Nursing.

    Reference category: independent clinical reference.

  10. de la Cruz M, Noguera A, San Miguel-Arregui MT, Williams J, Chisholm G, Bruera E (2015). Delirium, agitation, and symptom distress within the final seven days of life among cancer patients receiving hospice care. Palliative & supportive care.

    Reference category: other comparator or secondary accuracy evidence.

  11. Spedale V, Di Mauro S, Del Giorno G, Barilaro M, Villa CE, Gaudreau JD, Ausili D (2017). Delirium assessment in hospitalized elderly patients: Italian translation and validation of the nursing delirium screening scale. Aging clinical and experimental research.

    Reference category: other comparator or secondary accuracy evidence.

  12. Hargrave A, Bastiaens J, Bourgeois JA, Neuhaus J, Josephson SA, Chinn J, Lee M, Leung J, Douglas V (2017). Validation of a Nurse-Based Delirium-Screening Tool for Hospitalized Patients. Psychosomatics.

    Reference category: independent clinical reference.

  13. Brich J, Baten V, Wußmann J, Heupel-Reuter M, Perlov E, Klöppel S, Busch HJ (2019). Detecting delirium in elderly medical emergency patients: validation and subsequent modification of the German Nursing Delirium Screening Scale. Internal and emergency medicine.

    Reference category: independent clinical reference.

  14. Heinrich TW, Kato H, Emanuel C, Denson S (2019). Improving the Validity of Nurse-Based Delirium Screening: A Head-to-Head Comparison of Nursing Delirium-Screening Scale and Short Confusion Assessment Method. Psychosomatics.

    Reference category: independent clinical reference.

  15. Çınar F, Eti Aslan F (2019). Evaluation of Postoperative Delirium: Validity and Reliability of the Nursing Delirium Screening Scale in the Turkish Language. Dementia and geriatric cognitive disorders extra.

    Reference category: independent clinical reference.

  16. Bergjan M, Zilezinski M, Schwalbach T, Franke C, Erdur H, Audebert HJ, Hauß A (2020). Validation of two nurse-based screening tools for delirium in elderly patients in general medical wards. BMC nursing.

    Reference category: independent clinical reference.

  17. Nacul FE, Paul N, Spies CD, Sechting H, Hecht T, Dullinger JS, Piper SK, Luetz A, Balzer FS, Wernecke KD, Sa AK, Barros Ferreira da Costa C, Eymold L, Chenitir C, Weiss B (2020). Influence of Sedation Level and Ventilation Status on the Diagnostic Validity of Delirium Screening Tools in the ICU-An International, Prospective, Bi-Center Observational Study (IDeAS). Medicina (Kaunas, Lithuania).

    Reference category: independent clinical reference.

  18. Ntalouka MP, Bareka M, Brotis AG, Chalkias A, Stamoulis K, Flossos A, Tzimas P, Arnaoutoglou E (2020). Translation and cultural adaptation of the Greek version of the confusion assessment method diagnostic algorithm and the nursing delirium screening scale and their inter-rater reliability: A prospective cohort study. Hippokratia.

    Reference category: other comparator or secondary accuracy evidence.

  19. Blažena Ševčíková, Hana Matějovská Kubešová, Lenka Šáteková, Elena Gurková (2021). The validation of the Czech version of the Delirium Observation Scale and the Nursing Delirium Screening Scale for delirium screening in patients with locomotive apparatus trauma. Central European Journal of Nursing and Midwifery.

    Reference category: other comparator or secondary accuracy evidence.

  20. Fleischmann R, Warwas S, Andrasch T, Kunz R, Witt C, Mengel A, von Sarnowski B (2021). Course and Recognition of Poststroke Delirium: A Prospective Noninferiority Trial of Delirium Screening Tools. Stroke.

    Reference category: independent clinical reference.

  21. Amirajam Z, Asadi-Noran E, Molaei B, Adiban V, Heidarzadeh M, Hassanpour-Darghah M (2021). Psychometric Properties of Nursing Delirium Screening Scale in Patients Admitted to Intensive Care Units. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine.

    Reference category: independent clinical reference.

  22. Somnuke P, Limprapassorn P, Srinonprasert V, Wongviriyawong T, Suraarunsumrit P, Morkphrom E, Sura-Amonrattana U, Phannarus H, Choorerk D, Radtke FM, Chaiwat O (2022). The Thai version of the nursing delirium screening scale-Thai: Adaptation and validation study in postoperative patients. Frontiers in medicine.

    Reference category: independent clinical reference.

  23. Henao Castaño ÁM, Lozano González LM, Gómez Tovar LO (2023). Validation to Spanish of nursing assessment scale for early diagnosis of delirium - Nu-DESC. Investigacion y educacion en enfermeria.

    Reference category: other comparator or secondary accuracy evidence.

  24. Fabrizi D, Rebora P, Spedale V, Locatelli G, Bellelli G, Di Mauro S, Ausili D, Luciani M (2024). Diagnostic Accuracy of the Recognizing Acute Delirium as Part of Your Routine (RADAR) Scale for Delirium Assessment in Hospitalized Older Adults: A Cross-Sectional Study. Healthcare (Basel, Switzerland).

    Reference category: other comparator or secondary accuracy evidence.

Copyright and reuse
Version
Original Nu-DESC shown as Figure 1 in the 2005 paper
Information checked
2026-07-19

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

Base clinical review: 2026-08-30. Instrument description source check: 2026-09-05. Scope and limitations.