Asking just two questions can help nurses and doctors quickly and easily identify delirium in hospitalized older adults.
Delirium is a reversible cognitive condition that can be resolved if caught and treated early.
“Delirium can be very costly and deadly—and with high-risk patients, time matters,” says Donna M. Fick, professor of nursing and co-director of the Hartford Center of Geriatric Nursing Excellence at Penn State. “Our ultra-brief two-item bedside test for delirium takes an average of 36 seconds to perform and has a sensitivity of 93 percent.”
Edward R. Marcantonio, professor of medicine at Harvard Medical School, developed the 3D-CAM, a three-minute confusion assessment method, to help identify patients with delirium quickly. However, this method is more complicated than the ultra-brief screening and can still take a significant amount of time to administer.
The researchers wanted to develop something that would be easier to use at the bedside and take less time out of a busy nurse’s day.
“We started by looking for one question that could detect delirium, but we could only get 83 percent sensitivity, which is not good enough,” Fick says. She and her colleagues report their findings online in the Journal of Hospital Medicine.
Asking patients the day of the week and to recite the months of the year backward had a 93 percent sensitivity in identifying delirium. If a patient failed to answer the questions correctly—indicating delirium—the 3D-CAM assessment was then administered.
Of the 201 participants enrolled in this study, 42 were clinically diagnosed with delirium using a reference standard for delirium that included a 45-minute face-to-face interview. The ultra-brief two-item screening identified 48 percent, or 96 patients, as possibly delirious—39 were identified correctly, 57 were false positives, and 3 patients who did have delirium were not caught by the test
“These results still need to be validated, with a very large sample,” Fick says, before the test can be recommended for everyday use.
The researchers plan to continue the research at multiple sites with hundreds of participants in the near future to further determine the test’s validity as well as how easily the test can be implemented in real-world situations.
Other researchers from Brown University, Harvard Medical School, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, and the University of Massachusetts Medical School are coauthors of the study.
Source: Penn State
Correction: This story was updated on Sept. 17, 2015, to include more details about the results of the screening process.