Recognition of Delirium in Postoperative Elderly Patients: A Multicenter Study

Area of Science:

• Geriatric Medicine
• Neuroscience
• Critical Care Medicine

Background:

• Delirium is a common and serious complication in elderly postoperative patients.
• Accurate and timely diagnosis of delirium is crucial for effective management and improved patient outcomes.
• Current diagnostic methods rely heavily on clinical assessment, which can be subjective.

Purpose of the Study:

• To assess interrater reliability among delirium experts in diagnosing delirium from identical clinical information.
• To evaluate the sensitivity of commonly used delirium screening tools administered by clinical nurses in a real-world setting.

Main Methods:

• A prospective observational longitudinal study was conducted across three Dutch medical centers.
• 167 elderly postoperative patients were assessed daily for delirium on postoperative days 1-3.
• Videos of cognitive assessments and clinical data were independently reviewed by two delirium experts, with a third expert consulted for disagreements. Screening tool performance was compared to expert consensus.

Main Results:

• Considerable disagreement was found among delirium experts, with an overall weighted Cohen's kappa of 0.61.
• A third expert was required for final classification in 21% of assessments due to lack of consensus.
• Delirium screening tools administered by nurses demonstrated low sensitivity, detecting only 32% of expert-identified delirium cases.

Conclusions:

• Expert disagreement highlights the inherent difficulties in diagnosing delirium based on current clinical criteria.
• The low sensitivity of routine nursing delirium screening underscores the need for improved diagnostic approaches.
• Future research should prioritize the development of more objective instruments for delirium diagnosis.