Validity and Reliability of the Thai Version of the Delirium Diagnostic Tool-Provisional (DDT-Pro-TH) in Perioperative Patients With Fragility Hip Fractures

Abstract

BACKGROUND The incidence of fragility hip fractures (FHF) is increasing in older adults, and delirium often follows physical stress such as FHF. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the reference standard for diagnosing delirium in Thailand but requires specialized expertise. The Delirium Diagnostic Tool-Provisional (DDT-Pro) - a reliable and valid alternative that does not require specialist training - has not been evaluated in older Thai patients with FHF. This study aimed to translate and cross-culturally adapt the DDT-Pro to create a Thai version (DDT-Pro-TH), then determine its validity and reliability. MATERIAL AND METHODS A multidisciplinary team of nonpsychiatrists (orthopedists, geriatricians, anesthesiologists, physiatrists) and 2 DDT-Pro psychiatry experts performed forward and backward translation. Patients with FHF were informed about and consented to participation in this cross-sectional validation study. The DDT-Pro-TH and DSM-5 were independently utilized for delirium assessment before surgery and on postoperative days 1 and 2. Delirium diagnosed by DSM-5 served as the reference standard; DDT-Pro-TH positivity was defined as a score of 6 or lower. Validity was assessed with the area under the curve (AUC); reliability was measured using Cronbach's alpha and Cohen's kappa statistics. RESULTS One hundred ten patients with FHF participated. Internal consistency reliability (Cronbach's alpha) was 0.819 (95% CI, 0.783-0.851). Inter-rater reliability (Cohen's kappa) was 0.974 (95% CI, 0.962-0.982). Concurrent validity (AUC vs Thai DSM-5) was 0.959 (95% CI, 0.903-0.987). CONCLUSIONS The Thai version of the DDT-Pro is a highly reliable and valid instrument for diagnosing delirium in older patients with FHF.