Delirium in the Emergency Department: Novel Screening
| Status: | Completed |
|---|---|
| Conditions: | Hospital, Neurology, Psychiatric |
| Therapuetic Areas: | Neurology, Psychiatry / Psychology, Other |
| Healthy: | No |
| Age Range: | 65 - Any |
| Updated: | 5/5/2018 |
| Start Date: | July 2009 |
| End Date: | February 2012 |
Delirium is an acute confusional state characterized by altered or fluctuating mental status,
inattention, and either disorganized thinking or an altered level of consciousness. This form
of organ dysfunction occurs in up to 10% of older emergency department (ED) patients and is
associated with worsening mortality, prolonged hospital length of stay, higher health care
costs, and accelerated functional and cognitive decline. Despite the negative consequences of
delirium, the majority of cases are unrecognized by emergency physicians because it is not
routinely screened for. In an effort to facilitate delirium screening, the investigators
sought to validate three brief delirium assessments in the ED setting.
inattention, and either disorganized thinking or an altered level of consciousness. This form
of organ dysfunction occurs in up to 10% of older emergency department (ED) patients and is
associated with worsening mortality, prolonged hospital length of stay, higher health care
costs, and accelerated functional and cognitive decline. Despite the negative consequences of
delirium, the majority of cases are unrecognized by emergency physicians because it is not
routinely screened for. In an effort to facilitate delirium screening, the investigators
sought to validate three brief delirium assessments in the ED setting.
Delirium is often missed because emergency physicians do not routinely screen for this
diagnosis. Most delirium assessments can take up to 10 minutes to perform making them less
likely to be incorporated into the routine physician assessment. Using brief (<2 minutes) and
easy to use delirium assessments may ameliorate this quality of care issue. The Confusion
Assessment Method for the Intensive Care Unit (CAM-ICU) possesses these characteristics, but
has only been validated in mechanically and non-mechanically ventilated intensive care unit
patients. Recently, the investigators also developed the Brief Confusion Assessment Method
(B-CAM) which is a modification of the CAM-ICU. The benefit is that it takes even less time
than the CAM-ICU. The investigators also developed the Emergency Department Delirium Triage
Screen (ED-DTS) designed to be highly sensitive and moderately specific delirium assessment
for the nurse's triage assessment. It is hypothesized that a negative ED-DTS would rule out
delirium, while a positive ED-DTS would require a more formal delirium assessment such as the
CAM-ICU and B-CAM. These new delirium assessments require validation in older ED patients. As
result, the investigators propose the following and the following specific aims:
Aim #1: To validate the B-CAM in older ED patients. The B-CAM will be performed by a clinical
trials associate (CTA) and principal investigator in 200 ED patients that are > 65 years old.
This instrument will be validated against a psychiatrist's Diagnostic and Statistical Manual
of Mental Disorders, 4th. Edition Text Revision assessment as the reference standard.
Aim #2: To validate the CAM-ICU in older ED patients. The CAM-ICU will be performed by a
clinical trials associate (CTA) and principal investigator in approximately 200 ED patients
that are > 65 years old. This instrument will be validated against a psychiatrist's
Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition Text Revision assessment
as the reference standard.
Aim #3: To validate the ED-DTS in older ED patients. The ED-DTS will be performed by a
clinical trials associate (CTA) and principal investigator in 200 ED patients that are > 65
years old. This instrument will be validated against a psychiatrist's Diagnostic and
Statistical Manual of Mental Disorders, 4th. Edition Text Revision assessment as the
reference standard.
diagnosis. Most delirium assessments can take up to 10 minutes to perform making them less
likely to be incorporated into the routine physician assessment. Using brief (<2 minutes) and
easy to use delirium assessments may ameliorate this quality of care issue. The Confusion
Assessment Method for the Intensive Care Unit (CAM-ICU) possesses these characteristics, but
has only been validated in mechanically and non-mechanically ventilated intensive care unit
patients. Recently, the investigators also developed the Brief Confusion Assessment Method
(B-CAM) which is a modification of the CAM-ICU. The benefit is that it takes even less time
than the CAM-ICU. The investigators also developed the Emergency Department Delirium Triage
Screen (ED-DTS) designed to be highly sensitive and moderately specific delirium assessment
for the nurse's triage assessment. It is hypothesized that a negative ED-DTS would rule out
delirium, while a positive ED-DTS would require a more formal delirium assessment such as the
CAM-ICU and B-CAM. These new delirium assessments require validation in older ED patients. As
result, the investigators propose the following and the following specific aims:
Aim #1: To validate the B-CAM in older ED patients. The B-CAM will be performed by a clinical
trials associate (CTA) and principal investigator in 200 ED patients that are > 65 years old.
This instrument will be validated against a psychiatrist's Diagnostic and Statistical Manual
of Mental Disorders, 4th. Edition Text Revision assessment as the reference standard.
Aim #2: To validate the CAM-ICU in older ED patients. The CAM-ICU will be performed by a
clinical trials associate (CTA) and principal investigator in approximately 200 ED patients
that are > 65 years old. This instrument will be validated against a psychiatrist's
Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition Text Revision assessment
as the reference standard.
Aim #3: To validate the ED-DTS in older ED patients. The ED-DTS will be performed by a
clinical trials associate (CTA) and principal investigator in 200 ED patients that are > 65
years old. This instrument will be validated against a psychiatrist's Diagnostic and
Statistical Manual of Mental Disorders, 4th. Edition Text Revision assessment as the
reference standard.
Inclusion Criteria:
- 65 years of age or greater
- In the Emergency Department for less than 12 hour at the time of enrollment
Exclusion Criteria:
- Severe mental retardation or dementia
- Baseline communication barriers such as aphasia, deafness, blindness, or who are
unable to speak English
- Refusal of consent
- Previous enrollment
- Comatose
- Out of the hospital before the assessments are completed
We found this trial at
1
site
1211 Medical Center Dr
Nashville, Tennessee 37232
Nashville, Tennessee 37232
(615) 322-5000
Vanderbilt Univ Med Ctr Vanderbilt University Medical Center (VUMC) is a comprehensive healthcare facility dedicated...
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