• ED Manag. 2014 Oct 1;26(10):113-6.

AbstractWhile many older patients experience symptoms of delirium while in the emergency setting, the condition often is not recognized by emergency providers. Further, a missed diagnosis can lead to enhanced caregiver stress as well as a higher risk of institutionalization, readmission, and death. Experts suggest that providers need to be better educated on the subtle clues that a patient may be delirious so that steps can be taken to find and address the inciting cause. Research shows that delirium is present in 7% to 10% of older patients who present to the ED, but it is unrecognized about 75% of the time. Most cases of delirium involve what is called the hypoactive subtype in which patients appear to be sedate or depressed, and they have difficulty paying attention. Many patients with hypoactive delirium are mistaken as being depressed, and as a result, this is a subtype that is frequently missed by clinicians. While no screening tool is 100% effective, researchers have had the best success with a two-step process that involves use of a rapid Delirium Triage Screen (DTS) to rule out delirium. Patients who are not ruled out by the DTS then undergo a more formal Brief Confusion Assessment Method or B-CAM, a tool that is a modified form of the CAM-ICU.

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