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Unrecognized delirium in ED geriatric patients
L M Lewis1, D K Miller, J E Morley
1Emergency Medicine Division, St. Louis University Health Sciences Center, MO.
The American Journal of Emergency Medicine
|March 1, 1995
Summary
Emergency physicians recognized delirium in only 17% of elderly patients. The validated Confusion Assessment Method (CAM) is more sensitive for detecting acute confusional states in the Emergency Department.
Area of Science:
- Geriatrics
- Emergency Medicine
- Psychiatry
Background:
- Acute confusional states (delirium) are common in elderly Emergency Department (ED) patients.
- Early recognition of delirium is crucial for appropriate management and improved patient outcomes.
Purpose of the Study:
- To compare the sensitivity of conventional emergency physician evaluation with the Confusion Assessment Method (CAM) for detecting delirium in elderly ED patients.
- To assess the rate of delirium recognition by emergency physicians.
Main Methods:
- A cohort of 385 elderly patients (age > 64) presenting to an urban teaching hospital ED was studied.
- Patients were assessed by ED physicians and by a study nurse using the CAM.
- ED records were reviewed for delirium diagnosis and disposition.
Main Results:
- 10% of patients screened met criteria for delirium or probable delirium (38/385).
- Delirium was diagnosed by the ED physician in only 17% (6/35) of patients with confirmed delirium.
- Among admitted patients, "rule out sepsis" was the most common ED diagnosis for those with delirium.
Conclusions:
- Conventional ED evaluation has low sensitivity for detecting delirium in elderly patients.
- The Confusion Assessment Method (CAM) demonstrates higher sensitivity for identifying delirium in this population.
- Improved screening tools and physician education are needed for better delirium recognition in the ED.