Detecting Delirium Among Hospitalized Older Patients

doi:10.1001/archinte.1995.00430030095011

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Vol. 155 No. 3, 13 FEBRUARY 1995

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Detecting Delirium Among Hospitalized Older Patients

Peter Pompei, MD; Marquis Foreman, RN, PhD; Christine K. Cassel, MD; Cathy Alessi, MD; Deon Cox, DO

Arch Intern Med. 1995;155(3):301-307.

Abstract

Background
Delirium occurs commonly among older hospitalized patients andis frequently not recognized. In an effort to identify toolsuseful to clinicians in the diagnosis of delirium, test characteristicsof four screening instruments were compared.

Methods
Patients 65 years of age or older who were admitted to one offour medical and surgical wards of a university teaching hospitalwere followed up prospectively. Potential subjects were excludedif unavailable for interviews or discharged within 48 hoursof admission, or if judged too impaired to participate in thedaily interviews. Research assistants administered four instrumentsused to detect delirium: Digit Span Test, Vigilance 'A' Test,Clinical Assessment of Confusion, and Confusion Assessment Method.Abnormal scores on these tests or suspicion of acute confusionprompted a referral to the clinician-investigators who thenassessed the patient daily for delirium based on the Diagnosticand Statistical Manual of Mental Disor- ders, Revised ThirdEdition criteria.

Results
Delirium occurred in 64 (14.8%) of 432 subjects. The positivelikelihood ratios for all of the instruments were significantlymore than 1. The instruments remained useful when applied toselected subgroups: subjects in whom acute mental status changeswere documented, subjects on surgical services, and subjectswith impaired cognitive status on admission. Combinations ofany two instruments did not perform substantially better thanthe instrument with the best test characteristics: the ClinicalAssessment of Confusion. All instruments were more useful atconfirming delirium than in excluding it.

Conclusion
The four instruments studied, which are suitable for use atthe bedside, can aid the clinician in identifying patients likelyto be suffering from delirium.

(Arch Intern Med. 1995;155:301-307)

Author Affiliations

From The University of Chicago (Ill). Dr Pompei is now with the Stanford (Calif) University School of Medicine.

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