Does this patient have delirium?: value of bedside instruments

Area of Science:

• Gerontology
• Neuroscience
• Clinical Medicine

Background:

• Delirium is a common and serious condition in hospitalized older adults, often leading to adverse outcomes like mortality and long-term care placement.
• Despite its prevalence and consequences, delirium is frequently underrecognized by healthcare professionals.
• Simple, accurate bedside diagnostic instruments are needed to improve delirium identification.

Purpose of the Study:

• To systematically review the diagnostic accuracy of various bedside instruments used for identifying delirium in adult inpatients.
• To compare the effectiveness of different delirium screening tools in a clinical setting.

Main Methods:

• A comprehensive literature search was conducted across MEDLINE and EMBASE databases, supplemented by reference list reviews.
• Included studies were prospective diagnostic accuracy investigations comparing bedside delirium instruments against a gold standard diagnosis.
• The gold standard diagnosis was determined by geriatricians, psychiatrists, or neurologists using DSM-IV criteria.

Main Results:

• Twenty-five studies involving 3027 patients and 11 different instruments were analyzed.
• Several instruments, including the Confusion Assessment Method (CAM), showed high accuracy (positive likelihood ratios > 5.0) for detecting delirium.
• The CAM demonstrated the best overall performance, with a summary-positive likelihood ratio of 9.6 and a summary-negative likelihood ratio of 0.16, indicating strong diagnostic utility.

Conclusions:

• The Confusion Assessment Method (CAM) is the most evidence-supported bedside instrument for diagnosing delirium.
• The CAM is efficient, requiring only 5 minutes for administration, making it practical for busy clinical environments.
• Instrument selection may depend on available time and examiner discipline, but the CAM offers the most robust data for accurate delirium detection.