What is the Delirium Triage Screen (DTS)?

DTS is an ultra-brief two-step delirium screening tool designed for use in high-throughput hospital settings. It takes under 20 seconds to administer and consists of checking arousal (RASS), asking the patient to state their name, and asking them to recite the days of the week backward.

What are the sensitivity and specificity of DTS?

DTS has a reported sensitivity of approximately 98% and specificity of 55% for delirium. Its high sensitivity ensures very few delirium cases are missed; the lower specificity means some false positives will occur, which is why confirmatory assessment follows.

Why does DTS check arousal first?

Patients with RASS scores of −4 or −5 (deeply sedated or unarousable) cannot meaningfully participate in attention tasks. Proceeding to DTS in unarousable patients would produce false-negative results. RASS screening first protects data integrity.

Who developed DTS and in what population was it validated?

DTS was developed by Jin H. Han and colleagues and validated primarily in emergency department adult populations. The DTS + bCAM two-step protocol was described in a landmark 2013 study published in JAMA Internal Medicine.

What tool should follow a positive DTS?

The validated second step is the Brief Confusion Assessment Method (bCAM), which provides higher specificity. Other acceptable confirmatory tools include the standard CAM or 4AT. The choice depends on training and institutional protocol.

Can a negative DTS rule out delirium?

A negative DTS makes delirium unlikely given its 98% sensitivity, but it does not completely exclude it. Delirium fluctuates, so re-screening at each assessment period is needed. Clinical concern should always override a negative screen.

How does DTS fit into a two-step delirium protocol?

DTS acts as Stage 1: applied to all patients rapidly, flagging those who need Stage 2 (bCAM or CAM). This preserves the sensitivity of universal screening while limiting the time burden of detailed assessment to high-risk patients.

Can nurses administer DTS without specialist training?

Yes. DTS requires minimal training to administer reliably. This was a deliberate design feature, allowing universal delirium screening without dependence on specialist personnel. Brief standardised training is recommended to ensure consistent application.

Is DTS appropriate for patients on the ICU?

For intubated or heavily sedated ICU patients, CAM-ICU is the validated standard because it uses non-verbal attention testing. DTS is best suited for awake or lightly sedated ward patients where verbal testing is feasible.

How does DTS compare to the 4AT?

The 4AT is a more comprehensive screen (4 items including alertness, orientation, attention, and acute change) with higher specificity than DTS. DTS is faster but less specific; 4AT is slightly slower but can function both as a screen and a quasi-diagnostic tool.

What is the frequency of DTS re-screening recommended?

Given delirium's fluctuating nature, re-screening at minimum every 8–12 hours (each nursing shift) is common practice. More frequent screening is warranted in post-operative patients, high-risk medical patients, and following any acute clinical change.

Online Medical Tools — DTS

Printed on 9/3/2026

For informational purposes only. This is not medical advice.

Geriatrics

DTS

The Delirium Triage Screen (DTS) is a rapid first-pass delirium screen intended for high-throughput care settings. It is commonly used as an initial triage step before a more specific confirmatory instrument such as bCAM or CAM.

Formula: DTS output is binary: positive or negative screen.

DTS result

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How It Works

Assess Arousal With RASS

First evaluate the patient's level of arousal using the Richmond Agitation-Sedation Scale (RASS). If the RASS score is −4 (deep sedation) or −5 (unarousable), delirium cannot be assessed and DTS is not applicable. Document as 'unable to assess' and reassess when arousal improves.

Perform the Two Brief Tasks

Step 1: Ask the patient to say their own name. Step 2: Ask the patient to recite the days of the week backward. Both tasks test attention — the core domain disrupted in delirium. The entire assessment takes under 20 seconds.

Interpret the Result and Escalate if Positive

If the patient successfully completes both tasks, DTS is negative and delirium is unlikely — no further delirium workup needed in that screening cycle. If the patient fails either task, DTS is positive. Proceed immediately to a confirmatory instrument such as bCAM or CAM-ICU to determine whether delirium is present.

Who Uses the DTS

Emergency Department Universal Delirium Screening

Emergency nurses and triage staff

DTS enables all-patient delirium screening in busy emergency departments where time pressure prevents use of longer instruments. Positive screens are immediately referred for bCAM confirmation.

Acute Medical Ward Admission Screening

Admitting nurses and medical registrars

With 98% sensitivity, DTS functions as a reliable first-pass filter on acute medical wards. Any patient who fails either task is immediately flagged for confirmatory CAM or bCAM assessment.

Two-Step Delirium Detection Programme

Hospital delirium programme coordinators

DTS is designed as Stage 1 in the validated DTS + bCAM two-step protocol, balancing high-volume sensitivity with efficient resource use by reserving longer confirmatory tools for positive screens only.

Night or Weekend Staff Delirium Triage

On-call nurses and overnight medical teams

DTS requires no specialised training and can be reliably administered by any clinical staff, making it valuable when specialist delirium assessment teams are unavailable.

High-Throughput Post-Operative Monitoring

Post-anaesthetic care nurses and surgical ward teams

Post-operative delirium is common and under-detected. DTS allows rapid repeated monitoring every few hours in the post-operative period, catching early delirium onset before full assessment is needed.

Pro Tips

DTS is for Screening, Not Diagnosis

A positive DTS result means delirium is possible; it does not confirm delirium. Always follow with bCAM or CAM to confirm diagnosis. A negative DTS makes delirium unlikely but does not rule out subsyndromal delirium.

Check RASS First — Always

Attempting DTS on an unarousable patient (RASS −4 or −5) is meaningless. Make RASS assessment the mandatory first step. If RASS is −3 (deep sedation with response to voice), assessment may still be unreliable; use judgment.

Days of Week Backward Tests Attention Specifically

The days-of-week-backward task is particularly sensitive for attentional deficits — the core cognitive deficit in delirium. Patients with mild dementia but no acute delirium can usually complete this task. Failure suggests active delirium superimposed on baseline.

Build DTS Into Every Nursing Assessment

To achieve universal screening, embed DTS into the routine nursing assessment documentation — same frequency as vital signs checks. Standardised prompts in the electronic health record help maintain compliance.

Re-screen Every 12 Hours at Minimum

Delirium is fluctuating by nature. A negative DTS at one time point does not preclude delirium developing hours later. Re-screen at minimum every shift change and after any acute clinical event.

Note the Reason for Unable to Assess

When DTS cannot be completed (RASS ≤ −4, severe aphasia, complete unresponsiveness), document 'unable to assess — reason' rather than a negative result. This prevents misleading documentation and ensures appropriate follow-up when the patient's status changes.

DTS Misses Hypoactive Delirium Less Than You Think

Hypoactive delirium is often missed by clinical impression but not by DTS — inattention is present in both hyperactive and hypoactive subtypes. The days-backward task catches even quiet, withdrawn patients who fail due to attentional impairment.

Sensitivity 98% Means Rare False Negatives

DTS is intentionally designed with near-maximal sensitivity to minimise missed delirium cases. False positives (DTS positive but bCAM negative) are expected and acceptable; they simply trigger a brief confirmatory assessment, not treatment.

Common Questions About Your Results

Evidence-Based Methodology

DTS has validation evidence as part of two-step delirium detection pathways in acute care.

Clinical Content Trust

Last reviewed:: April 21, 2026
Guideline version:: Delirium Screening Review 2026.04
Source set version:: DTS source set v1

How to Interpret Your Result

A positive DTS suggests possible delirium and indicates need for confirmatory assessment and management pathway.

When to Use This Tool

Use when rapid delirium triage is needed in emergency or acute-care intake workflows.

Limitations

As a triage screen, DTS is not definitive and should be paired with a higher-specificity follow-up tool.

Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.

Sources

Changelog

April 21, 2026 · v1.0.0
Added DTS calculator entry with evidence note, source links, and trust metadata fields.

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