Editing Delirium (section)

=== General settings ===
Guidelines recommend that delirium should be diagnosed consistently when present.<ref name = SIGN /><ref name = NICE>{{Cite web| title=Delirium: Prevention, diagnosis and management in hospital and long-term care| url=https://www.nice.org.uk/guidance/cg103| website=National Institute for Health and Care Excellence| date=28 July 2010| access-date=2023-01-31| archive-date=2023-06-09| archive-url=https://web.archive.org/web/20230609150014/https://www.nice.org.uk/guidance/CG103| url-status=live}}</ref> Much evidence reveals that in most centers delirium is greatly under-diagnosed.<ref>{{Cite journal | vauthors = Ibitoye T, So S, Shenkin SD, Anand A, Reed MJ, Vardy ER, Pendlebury ST, MacLullich AM |date=2023-05-15 |title=Delirium is under-reported in discharge summaries and in hospital administrative systems: a systematic review |url=https://deliriumjournal.com/article/74541-delirium-is-under-reported-in-discharge-summaries-and-in-hospital-administrative-systems-a-systematic-review |journal=Delirium |language=en |doi=10.56392/001c.74541|pmid=39654697 |pmc=7617113 }}</ref><ref>{{cite journal | vauthors = Bellelli G, Nobili A, Annoni G, Morandi A, Djade CD, Meagher DJ, Maclullich AM, Davis D, Mazzone A, Tettamanti M, Mannucci PM | title = Under-detection of delirium and impact of neurocognitive deficits on in-hospital mortality among acute geriatric and medical wards | journal = European Journal of Internal Medicine | volume = 26 | issue = 9 | pages = 696–704 | date = November 2015 | pmid = 26333532 | doi = 10.1016/j.ejim.2015.08.006 }}</ref><ref name="Sepulveda_2016">{{cite journal | vauthors = Sepulveda E, Franco JG, Trzepacz PT, Gaviria AM, Meagher DJ, Palma J, Viñuelas E, Grau I, Vilella E, de Pablo J | title = Delirium diagnosis defined by cluster analysis of symptoms versus diagnosis by DSM and ICD criteria: diagnostic accuracy study | journal = BMC Psychiatry | volume = 16 | issue = | pages = 167 | date = May 2016 | pmid = 27229307 | pmc = 4882791 | doi = 10.1186/s12888-016-0878-6 | doi-access = free }}</ref><ref>{{cite journal | vauthors = McCoy TH, Snapper L, Stern TA, Perlis RH | title = Underreporting of Delirium in Statewide Claims Data: Implications for Clinical Care and Predictive Modeling | journal = Psychosomatics | volume = 57 | issue = 5 | pages = 480–488 | year = 2016 | pmid = 27480944 | doi = 10.1016/j.psym.2016.06.001 | s2cid = 3300073 }}</ref> A systematic review of large scale routine data studies reporting data on delirium detection tools showed important variations in tool completion rates and tool positive score rates. Some tools, even if completed at high rates, showed delirium positive score rates that there much lower than the expected delirium occurrence level, suggesting low sensitivity in practice.<ref>{{cite journal | vauthors = Penfold RS, Squires C, Angus A, Shenkin SD, Ibitoye T, Tieges Z, Neufeld KJ, Avelino-Silva TJ, Davis D, Anand A, Duckworth AD, Guthrie B, MacLullich AM | title = Delirium detection tools show varying completion rates and positive score rates when used at scale in routine practice in general hospital settings: A systematic review | journal = Journal of the American Geriatrics Society | volume = 72 | issue = 5 | pages = 1508–1524 | date = May 2024 | pmid = 38241503 | doi = 10.1111/jgs.18751 | doi-access = free }}</ref>

There is evidence that delirium detection and coding rates can show improvements in response to guidelines and education; for example, whole country data in England and Scotland (sample size 7.7M people per year) show that there were large increases (3-4 fold) in delirium coding between 2012 and 2020.<ref>{{cite journal | vauthors = Ibitoye T, Jackson TA, Davis D, MacLullich AM | title = Trends in delirium coding rates in older hospital inpatients in England and Scotland: full population data comprising 7.7M patients per year show substantial increases between 2012 and 2020 | journal = Delirium Communications | volume = 2023 | pages = 84051 | date = July 2023 | pmid = 37654785 | pmc = 7614999 | doi = 10.56392/001c.84051 }}</ref> Delirium detection in general acute care settings can be assisted by the use of validated delirium screening tools. Many such tools have been published, and they differ in a variety of characteristics (e.g., duration, complexity, and need for training). It is also important to ensure that a given tool has been validated for the setting where it is being used.

Examples of tools in use in clinical practice include:
* [[Confusion Assessment Method]] (CAM),<ref>{{cite journal | vauthors = Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI | title = Clarifying confusion: the confusion assessment method. A new method for detection of delirium | journal = Annals of Internal Medicine | volume = 113 | issue = 12 | pages = 941–948 | date = December 1990 | pmid = 2240918 | doi = 10.7326/0003-4819-113-12-941 | s2cid = 7740657 }}</ref> including variants such as the 3-Minute Diagnostic Interview for the CAM (3D-CAM)<ref>{{cite journal | vauthors = Marcantonio ER, Ngo LH, O'Connor M, Jones RN, Crane PK, Metzger ED, Inouye SK | title = 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study | journal = Annals of Internal Medicine | volume = 161 | issue = 8 | pages = 554–561 | date = October 2014 | pmid = 25329203 | pmc = 4319978 | doi = 10.7326/M14-0865 }}</ref> and brief CAM (bCAM)<ref>{{cite journal | vauthors = Han JH, Wilson A, Vasilevskis EE, Shintani A, Schnelle JF, Dittus RS, Graves AJ, Storrow AB, Shuster J, Ely EW | title = Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method | journal = Annals of Emergency Medicine | volume = 62 | issue = 5 | pages = 457–465 | date = November 2013 | pmid = 23916018 | pmc = 3936572 | doi = 10.1016/j.annemergmed.2013.05.003 }}</ref>
* Delirium Observation Screening Scale (DOS)<ref>{{cite journal | vauthors = Schuurmans MJ, Shortridge-Baggett LM, Duursma SA | title = The Delirium Observation Screening Scale: a screening instrument for delirium | journal = Research and Theory for Nursing Practice | volume = 17 | issue = 1 | pages = 31–50 | date = 2003-01-01 | pmid = 12751884 | doi = 10.1891/rtnp.17.1.31.53169 | s2cid = 219203272 }}</ref>
* Nursing Delirium Screening Scale (Nu-DESC)<ref>{{cite journal | vauthors = Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA | title = Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale | journal = Journal of Pain and Symptom Management | volume = 29 | issue = 4 | pages = 368–375 | date = April 2005 | pmid = 15857740 | doi = 10.1016/j.jpainsymman.2004.07.009 | doi-access = free }}</ref>
* Recognizing Acute Delirium As part of your Routine (RADAR)<ref>{{cite journal | vauthors = Voyer P, Champoux N, Desrosiers J, Landreville P, McCusker J, Monette J, Savoie M, Richard S, Carmichael PH | title = Recognizing acute delirium as part of your routine [RADAR]: a validation study | journal = BMC Nursing | volume = 14 | pages = 19 | date = 2015-01-01 | pmid = 25844067 | pmc = 4384313 | doi = 10.1186/s12912-015-0070-1 | doi-access = free }}</ref>
* [[4AT]] (4 A's Test)<ref name="Tieges_2021">{{cite journal | vauthors = Tieges Z, Maclullich AM, Anand A, Brookes C, Cassarino M, O'connor M, Ryan D, Saller T, Arora RC, Chang Y, Agarwal K, Taffet G, Quinn T, Shenkin SD, Galvin R | title = Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis | journal = Age and Ageing | volume = 50 | issue = 3 | pages = 733–743 | date = May 2021 | pmid = 33951145 | pmc = 8099016 | doi = 10.1093/ageing/afaa224 }}</ref>
* Delirium Diagnostic Tool-Provisional (DDT-Pro),<ref>{{cite journal | vauthors = Kean J, Trzepacz PT, Murray LL, Abell M, Trexler L | title = Initial validation of a brief provisional diagnostic scale for delirium | journal = Brain Injury | volume = 24 | issue = 10 | pages = 1222–1230 | date = 2010 | pmid = 20645705 | doi = 10.3109/02699052.2010.498008 | s2cid = 27856235 }}</ref><ref>{{cite journal | vauthors = Franco JG, Ocampo MV, Velásquez-Tirado JD, Zaraza DR, Giraldo AM, Serna PA, López C, Zuluaga A, Sepúlveda E, Kean J, Trzepacz PT | title = Validation of the Delirium Diagnostic Tool-Provisional (DDT-Pro) With Medical Inpatients and Comparison With the Confusion Assessment Method Algorithm | journal = The Journal of Neuropsychiatry and Clinical Neurosciences | volume = 32 | issue = 3 | pages = 213–226 | date = 2020 | pmid = 31662094 | doi = 10.1176/appi.neuropsych.18110255 | doi-access = free }}</ref> also for subsyndromal delirium<ref>{{cite journal | vauthors = Franco JG, Trzepacz PT, Sepúlveda E, Ocampo MV, Velásquez-Tirado JD, Zaraza DR, Restrepo C, Giraldo AM, Serna PA, Zuluaga A, López C | title = Delirium diagnostic tool-provisional (DDT-Pro) scores in delirium, subsyndromal delirium and no delirium | journal = General Hospital Psychiatry | volume = 67 | pages = 107–114 | date = 2020 | pmid = 33091783 | doi = 10.1016/j.genhosppsych.2020.10.003 | s2cid = 225053525 }}</ref>