Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Editorial Comment
Ultrabrief delirium assessments--are they ready for primetime?
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Comparative Study Observational Study
Comparison of mental-status scales for predicting mortality on the general wards.
Altered mental status is a significant predictor of mortality in inpatients. Several scales exist to characterize mental status, including the AVPU (Alert, responds to Voice, responds to Pain, Unresponsive) scale, which is used in many early-warning scores in the general-ward setting. The use of the Glasgow Coma Scale (GCS) and Richmond Agitation Sedation Scale (RASS) is not well established in this population. ⋯ In ward patients, both GCS and RASS were significantly more accurate predictors of mortality than AVPU. In addition, combining GCS and RASS was more accurate than any scale alone. Routine tracking of GCS and/or RASS on general wards may improve the accuracy of detecting clinical deterioration.
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It is desirable not to include planned readmissions in readmission measures because they represent deliberate, scheduled care. ⋯ An administrative claims-based algorithm to identify planned readmissions is feasible and can facilitate public reporting of primarily unplanned readmissions.
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Review
The association between an ultrabrief cognitive screening in older adults and hospital outcomes.
Though often recommended, hospital cognitive assessment is infrequently completed due to clinical and time constraints. ⋯ Impaired performance on ultrabrief cognitive assessments of arousal and attention provide valuable insights regarding hospital outcomes.
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Delirium is common, morbid, and costly, yet is greatly under-recognized among hospitalized older adults. ⋯ We identified a single item with >80% and pair of items with >90% sensitivity for delirium. If validated prospectively, these items will serve as an initial innovative screening step for delirium identification in hospitalized older adults.