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Two-Question Screening Helps ID Delirium

Two-Question Screening Helps ID Delirium

Researchers have developed new assessment tools to help identify people with delirium.

Investigators say a new screen allows nurses and physicians to identify delirium among hospitalized older adults after responses to two questions. Detection of delirium is important because it is a reversible cognitive condition that can be resolved if caught and treated early.

Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of one’s environment.

“Delirium can be very costly and deadly, and with high-risk patients, time matters,” said Donna M. Fick, Ph.D., distinguished professor of nursing and co-director of the Hartford Center of Geriatric Nursing Excellence at Pennsylvania State University.

“Our ultra-brief two-item bedside test for delirium takes an average of 36 seconds to perform and has a sensitivity of 93 percent,” she said.

Edward R. Marcantonio, M.D., professor of medicine at Harvard Medical School, recently developed the 3D-CAM, a three-minute confusion assessment method, to help identify patients with delirium quickly.

Although this method is effective, it is still more complicated than the ultra-brief screening and can take a significant amount of time to administer. Fick and Marcantonio wanted to develop something that would be easier to use at the bedside and take less time out of a busy nurse’s day.

“We started by looking for one question that could detect delirium, but we could only get 83 percent sensitivity, which is not good enough,” said Fick. She and her colleagues report their findings online in the Journal of Hospital Medicine.

The researchers were able to find two questions that proved to have a 93 percent sensitivity in identifying delirium: patients were asked what day of the week it was and to recite the months of the year backwards. If a patient failed to answer these two questions correctly, indicating delirium, the 3D-CAM would be administered.

Of the 201 participants tested in this study, 42 were clinically diagnosed with delirium. The two-item test identified 48 as possibly delirious; 42 were identified correctly, with six false positives.

“These results still need to be validated, with a very large sample,” said Fick, before the test can be recommended for everyday use.

The researchers plan to use the tools with hundreds of participants in the near future to determine the test’s validity as well as how easily the test can be implemented in real-world situations.

Source: Pennsylvania State/EurekAlert

Two-Question Screening Helps ID Delirium

Rick Nauert PhD

Rick Nauert, PhDDr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.

APA Reference
Nauert PhD, R. (2018). Two-Question Screening Helps ID Delirium. Psych Central. Retrieved on December 3, 2020, from
Scientifically Reviewed
Last updated: 8 Aug 2018 (Originally: 16 Sep 2015)
Last reviewed: By a member of our scientific advisory board on 8 Aug 2018
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