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Am J Emerg Med. 2018 Jul;36(7):1249-1252. doi: 10.1016/j.ajem.2018.03.060. Epub 2018 Mar 22.

An evaluation of single question delirium screening tools in older emergency department patients.

Author information

1
Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States. Electronic address: Jin.h.han@vanderbilt.edu.
2
Department of Psychiatry, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
3
Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, United States; Division of Geriatrics, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, United States; Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, TN, United States.
4
Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, United States; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, TN, United States.
5
Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, United States; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, TN, United States.

Abstract

OBJECTIVES:

To determine the diagnostic performances of several single question delirium screens. To the patient we asked: "Have you had any difficulty thinking clearly lately?" To the patient's surrogate, we asked: "Is the patient at his or her baseline mental status?" and "Have you noticed the patient's mental status fluctuate throughout the course of the day?"

METHODS:

This was a prospective observational study that enrolled English speaking patients 65 years or older. A research assistant (RA) and emergency physician (EP) independently asked the patient and surrogate the single question delirium screens. The reference standard for delirium was a consultation-liaison psychiatrist's assessment using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria. All assessments were performed within 3 h and were all blinded to each other.

RESULTS:

Of the 406 patients enrolled, 50 (12%) were delirious. A patient who was unable to answer the question "Have you had any difficulty thinking clearly lately?" was 99.7% (95% CI: 98.0%-99.9%) specific, but only 24.0% (95% CI: 14.3%-37.4%) sensitive for delirium when asked by the RA. The baseline mental status surrogate question was 77.1% (95% CI: 61.0%-87.9%) sensitive and 87.5% (95% CI: 82.8%-91.1%) specific for delirium when asked by the RA. The fluctuating course surrogate question was 77.1% (95% CI: 61.0%-87.9%) sensitive and 80.2% (95% CI: 74.8%-84.7%) specific. When asked by the EP, the single question delirium screens' diagnostic performances were similar.

CONCLUSIONS:

The patient and surrogate single question delirium assessments may be useful for delirium screening in the ED.

KEYWORDS:

Assessment; Delirium; Emergency department; Geriatric

PMID:
29699898
DOI:
10.1016/j.ajem.2018.03.060
[Indexed for MEDLINE]

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