Search results powered by Vanderbilt University

for Medical Professionals — ABCDEs of Prevention and Safety

Adult Non-ICU Care: Monitoring Delirium

Assessing for delirium throughout the entire hospital system is a an important part of patient care. The choice of which delirium assessment(s) to use is dependent on your needs, goals, and patient populations. An excellent systematic review on a number of delirium assessment tools can be found at Wong et al. JAMA. 2010.

Below are descriptions of three tools available for use in non-ICU hospital settings:

The Delirium Triage Screen (DTS)

The Delirium Triage Screen (DTS) was designed to be the optional first step of a two-step delirium monitoring process for very busy clinical environments. The DTS is a 20 second assessment designed to rapidly rule-out delirium and reduce number of formal delirium assessments needed. It consists of a measure of level of consciousness and a brief measure of inattention. If negative, no additional testing is needed. If positive, confirmatory testing (Step 2) to rule-in delirium with more specific assessments such as the Brief Confusion Assessment Method (bCAM) or Confusion Assessment Method (CAM) are needed (described below). For additional details on how to perform the DTS, see the download link below.

In older 406 Emergency Department (ED) patients, the DTS was found to be 98% sensitive and 55% specific for delirium as diagnosed by a psychiatrist assessment (see manuscript link below). Though the DTS has been validated in older emergency department patients, its diagnostic performance appears to be similar in older patients who are admitted to the hospital.

Additional details about the DTS can be obtained by contacting jin.h.han@vanderbilt.edu.

Download
pdficon_large-1.png

DTS Flowsheet and Instructions


Diagnosing Delirium in Older Emergency Department Patients: Validity and Reliability of the Delirium Triage Screen and the Brief Confusion Assessment Method.

Han JH, Wilson A, Vasilevskis EE, Shintani A, Schnelle JF, Dittus RS, Graves AJ, Storrow AB, Shuster J, Ely EW. Ann Emerg Med. 2013;62:457-465.

Read on PubMed.gov

The Brief Confusion Assessment Method (bCAM)

The Brief Confusion Assessment Method (bCAM) was developed for use in the Emergency Department setting by modifying the CAM-ICU. The bCAM and CAM-ICU are very similar. However, one key difference is the test for attention has been changed to reciting the months backwards from December to July. For more instructions see the download links below. Like the CAM-ICU, the bCAM requires minimal training and takes the less than two minutes to perform. In the original validation study (see link below) that included 406 Emergency Department (ED) patients, the bCAM was found to be 84% sensitive and 96% when performed by a physician and 78% sensitive and 97% specific when performed by a non-physician. Though the bCAM has been validated in older emergency department patients, the diagnostic performances appear to be similar in patients who are admitted to hospital and this tool may be promising for use in other non-ICU settings.

pdficon_large-1.png

The bCAM Overview and Instructions

pdficon_large-1.png

bCAM Flowsheet


Diagnosing Delirium in Older Emergency Department Patients: Validity and Reliability of the Delirium Triage Screen and the Brief Confusion Assessment Method.

Han JH, Wilson A, Vasilevskis EE, Shintani A, Schnelle JF, Dittus RS, Graves AJ, Storrow AB, Shuster J, Ely EW. Ann Emerg Med. 2013; 62:457-465.

Read on PubMed.gov

Links

The Confusion Assessment Method (CAM)

Though many other delirium assessments have been studied for non-ICU patients, the Confusion Assessment Method (CAM) is the most widely studied and used. The CAM is also the progenitor of the CAM-ICU and bCAM. The original validation study observed that the CAM was 94% to 100% sensitive and 90% to 95% specific compared with a psychiatrist's assessment (Inouye et al. Ann Int Med.1990). Wong et al. performed a meta-analysis and observed a pooled sensitivity of 86% and pooled specificity of 93% (Wong et al. JAMA. 2010).

Additional details of the CAM can be found at Hospital Elder Life Program (HELP).