Objective screenings tend to improve delirium diagnoses

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Better diagnosis of delirium can shorten stays and lower costs.
Better diagnosis of delirium can shorten stays and lower costs.

Nurses and others who screen hospital patients for delirium tend to disagree on the diagnosis, according to a longitudinal study of three centers in the Netherlands.

Intensive care teams say their findings indicate a need for more reliable screenings to detect disturbances in attention and awareness, particularly among elderly and critically ill older adults.

“Delirium recognition in clinical practice by clinical nurses was poor, and many cases of delirium were unrecognized despite the use of (existing) delirium screening tools,” wrote report authors. The research team was led by doctoral student Tianne Numan of the University Medical Center Utrecht.

The study, published in the Journal of American Geriatrics Society, focused on 167 elderly, post-operative adults. Experts disagreed on the diagnosis in 89 cases. They used a standardized cognitive assessment and the delirium rating scale.

Tellingly, nurses detected 32% of cases later diagnosed by experts. 

“There is a clear need for an easy-to-use, reliable method of detecting delirium,” Numan wrote. “[Current] tools showed good performance, but interpretation by the performer is needed.”

Instead, the researchers want to see an alternative, objective tool that is applicable to every patient and unambiguous — possibly including a bipolar EEG screening or one-minute video recordings.