The Single Question in Delirium as a suitable tool to improve delirium detection in hospitalized older patients

Delirium remains underdiagnosed in hospitalized older patients. The Single Question in Delirium (SQiD) has emerged as a promising screening tool with a high negative predictive value in previous studies, but only a few have investigated the SQiD in geriatric patients. This study aimed to investigate the added value of combining the 4AT and SQiD for detecting delirium in hospitalized older patients. Secondary objectives included determining the point prevalence of delirium and healthcare professionals' awareness of delirium.

On World Delirium Awareness Day 2024, all patients aged 70 years and older in three German hospitals were screened for delirium using the 4AT and SQiD. To assess delirium awareness among healthcare professionals, both nurses and physicians were asked which patients they perceived as delirious, and discharge documentation was reviewed for mentions of delirium.

403 patients (mean age 81.3 ± 6.3 years, 55.3% female) were included. In 75.3% of cases, the results from SQiD alone and the 4AT alone were consistent. Combining both tools increased the detection rate of possible delirium from 20.3 to 31.3%. Delirium awareness was low: nurses and physicians correctly perceived patients as delirious in only 34.9% and 32.4%, respectively. Orientation deficits and altered alertness were associated with increased odds of staff awareness, attention deficits and a positive SQiD alone were not.

Combining the SQiD with the 4AT enhances the detection of possible delirium in older inpatients. Delirium awareness among healthcare professionals remains low and must be increased to ensure better detection, management, and ultimately patient outcomes.