Patients: New Tool Helps Detect Delirium

Photo: Doctor and patient

The condition, which occurs in as many as one in five hospitalized patients, tends to develop rapidly and can lead to higher death rates; © ltd

Researchers of the University of California San Francisco have developed a two-minute assessment tool to help hospital staff predict a patient’s risk of delirium, a change in mental cognition characterized by severe confusion and disorientation that can prolong hospital stays.

The condition, which occurs in as many as one in five hospitalized patients, tends to develop rapidly and can lead to higher death rates and increased health care costs.

The new tool is designed to be simple, efficient and accurate in helping to assess and treat patients at risk of developing delirium, the scientists said. The tool also can be used to identify patients who might be most suitable for new targeted interventions to prevent delirium, the authors reported.

“It is estimated that up to one third of hospital-acquired delirium cases could be prevented with appropriate interventions, but those interventions are resource-intense and can’t be applied to everyone,” said lead author Dr. Vanja C. Douglas.

“Our objective was to develop a tool to predict delirium using elements that could be assessed quickly in the fast-paced environment of a hospital,” Douglas said. “The new tool can be completed by a nurse in two minutes, and provides a clinically useful and practical alternative to existing delirium prediction models.”

Delirium, an often serious disturbance in a patient’s mental abilities, results in confused thinking and decreased awareness of one’s environment. The precise sequence of events that take place in the body and brain which results in delirium is not well understood, the researchers noted. It is believed that the combination of an aging brain and acute illness creates an imbalance of neurotransmitters that leads to the confusion and disorientation of delirium. Adding powerful medications like narcotics to the mix can compound the problem.

Established risk factors for delirium include: older age, preexisting cognitive dysfunction, dehydration, severe illness, vision and hearing impairment, electrolyte abnormalities and overmedication.

In the new study, some 374 patients took part - each was older than 50 and not delirious when admitted to the hospital. The patients were predominately white and lived at home. On admission, the patients underwent a structured interview involving questions related to their baseline cognitive function, residence, type of pain, visual and hearing abilities, among other factors. Each patient’s nurses rated them on a scale from “not ill” to near the point of death. All the patients were assessed for changes in cognition for six days or until they were discharged.

“It is imperative to be able to recognize those patients admitted to the hospital with medical conditions who are at risk for delirium so that they can be the focus of targeted prevention and treatment,” said senior author Dr. S. Andrew Josephson.; Source: University of California San Francisco