Which instruments can be used to assess delirium in hospitalized patients?

Updated: Apr 25, 2019
  • Author: Kannayiram Alagiakrishnan, MD, MBBS, MPH, MHA; Chief Editor: Glen L Xiong, MD  more...
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Answer

A simple cognitive test like the Mini-Cog can be a predictor of inhospital delirium. At the time of admission to the hospital, if the elderly patient does not have a history of dementia or cognitive impairment, the Mini-Cog can be used to identify patients at high risk for inhospital delirium.

The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) offers the clinician the opportunity to identify delirium in critical care patients, especially patients on mechanical ventilation. The CAM-ICU makes use of nonverbal assessments to evaluate the important features of delirium.

Another instrument that can be used in ICU settings is the Intensive Care Delirium Screening Checklist (ICDSC). The severity of delirium in the ICU can be estimated by the Delirium Detection Scale (DDS).

A 2012 meta-analysis showed a sensitivity of 75.5% and specificity of 95.8% for CAM-ICU, whereas sensitivity and specificity for the ICDSC were 80.1% and 74.6%, respectively. These results suggest the CAM-ICU is one of the most specific bedside tests that can be used to diagnose delirium in ICU patients. [28]

The CAM-S was developed for measuring the severity of delirium in hospitalized patients (short form) and those in research settings (long form). [29, 30]  Developers reported good psychometric properties, high interrater reliability, and strong associations with important clinical outcomes with this tool, which is based on the standardized and validated Confusion Assessment Method (CAM) that screens for the presence—but not the severity—of delirium. The CAM-S was tested in 2 independent cohorts at 3 academic centers comprising 300 patients scheduled for major surgery and 919 medical patients (all patients aged ≥70 y). [29, 30]


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