In a compelling advancement for neuropsychiatric diagnostics in China, a recent systematic review has meticulously evaluated the validity and reliability of Chinese adaptations of delirium assessment scales. Published in BMC Psychiatry, this comprehensive study sheds light on the evolving landscape of delirium screening tools adapted from English-language instruments and their applicability within Chinese clinical contexts. The authors rigorously examined thirteen delirium scales that had been translated and culturally adapted, providing critical insights into their methodological robustness and diagnostic accuracy.
Delirium, an acute neuropsychiatric syndrome characterized by fluctuating cognitive dysfunction and impaired consciousness, poses a significant challenge in healthcare due to underdiagnosis and overlap with other mental health conditions. Accurate and early identification using validated tools is paramount, particularly in aging populations and critical care settings where delirium incidence is high. This new study addresses a pivotal question: how well do delirium assessment tools, originally developed in English, perform when adapted for Chinese-speaking populations?
The researchers employed an extensive literature search across multiple databases including PubMed, Embase, Web of Science, and prominent Chinese biomedical databases such as CNKI, VIP, Wanfang, and CBM. The search spanned all available years until September 1, 2023, ensuring a robust inclusion of relevant studies. They focused solely on papers that either translated or culturally adapted delirium scales for Chinese adults aged 18 or older, with full text available for quality appraisal.
Methodological rigor was a cornerstone of the review. Two independent reviewers conducted the screening and data extraction processes, minimizing bias. The quality assessment utilized the QUADAS-2 tool—an established instrument for evaluating risk of bias in diagnostic accuracy studies—and the overall strength of evidence was graded with the GRADE framework enhanced by GRADE GPT technology. Due to the heterogeneity of included studies, the authors adopted a random-effects meta-analytic approach to synthesize diagnostic performance metrics such as sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC).
Results revealed the inclusion of thirteen studies evaluating thirteen distinctive delirium assessment scales, all translated adhering to rigorous procedures based on Brislin’s and ISPOR guidelines. Among these instruments, the 4AT scale emerged as the highest quality tool, displaying superior methodological characteristics. The 3D-CAM, CAM-ICU, CAM-ICU-7, and S-PTD scales also demonstrated commendable rigour and reliability.
Statistical analysis highlighted an impressive pooled sensitivity of 0.93 and a specificity of 0.94 across seven scales that provided suitable diagnostic data. The AUC values—nearing a remarkable 0.98—underscore the excellent discriminative power of these Chinese-adapted tools, aligning their performance closely with their original English counterparts. Internal consistency, as measured by Cronbach’s alpha, generally exceeded 0.8, while inter-rater reliability coefficients were commonly at or above 0.9, indicative of stable and reproducible measurement.
The study further evaluated content and construct validity through indices such as the Scale-Content Validity Index (S-CVI) and Item-Content Validity Index (I-CVI), with values exceeding 0.9 in three studies. These findings verify that the translated scales maintain semantic integrity and culturally relevant constructs, key factors for meaningful clinical application in diverse populations.
Despite robust findings, the authors acknowledge variability in recommended cut-off points across different scales, reflecting nuances in detecting delirium within heterogeneous patient cohorts. Such variability calls for ongoing refinement to optimize sensitivity without forfeiting specificity in various clinical settings, including primary care and intensive care units.
Importantly, the review concludes that Chinese versions of delirium assessment tools such as 3D-CAM, 4AT, CAM, CAM-ICU, CAM-ICU-7, and Nu-DESC are valid, reliable, and practical alternatives for healthcare providers in China. Their adoption could enhance early recognition and intervention for delirium, potentially improving patient outcomes and reducing healthcare costs attributable to delayed diagnosis.
The study also highlights the need for continuous research efforts aimed at improving scientific rigor and diagnostic accuracy of these tools. Given the dynamic nature of cross-cultural adaptations and changing clinical environments, iterative validation studies will ensure these instruments remain responsive to evolving healthcare demands.
This review represents a significant contribution by bridging the gap between English-language delirium assessment research and Chinese clinical practice, fostering greater standardization and evidence-based screening nationwide. With China’s aging population growing rapidly, the availability of validated delirium assessment scales is a timely and necessary development.
In summary, this groundbreaking diagnostic systematic review supports the clinical integration of several high-quality Chinese-adapted delirium scales, providing clinicians, researchers, and policymakers with evidence-based guidance. As the field moves forward, these tools are poised to become instrumental in enhancing delirium detection, enabling timely interventions and improving patient prognoses across diverse healthcare settings.
Subject of Research: Evaluation of Chinese-translated delirium assessment scales focusing on their validity, reliability, and diagnostic accuracy.
Article Title: Evaluating the Chinese versions of delirium assessment scales: a diagnostic systematic review
Article References:
Tang, C., Zhong, J., Wang, X. et al. Evaluating the Chinese versions of delirium assessment scales: a diagnostic systematic review.
BMC Psychiatry 25, 431 (2025). https://doi.org/10.1186/s12888-025-06745-z
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