Brief Delirium Assessments in Non-Intensive Care Unit (ICU) Patients



Status:Withdrawn
Conditions:Neurology, Psychiatric
Therapuetic Areas:Neurology, Psychiatry / Psychology
Healthy:No
Age Range:65 - 100
Updated:5/9/2018
Start Date:July 2013
End Date:July 2016

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Validation of Brief Delirium Assessments in Non Critically Ill Hospitalized Patients

Delirium is an acute confusional state characterized by fluctuating mental status,
inattention, and either disorganized thinking or an altered level of consciousness. This form
of organ dysfunction occurs in up to 50% of hospitalized 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 hospital physicians because it is not routinely
screened for. In an effort to facilitate delirium screening, we sought to validate two brief
delirium assessments (<2 minutes) in the hospital setting.

Delirium is often missed because 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.
As a result, it still requires validation in the non-ICU hospitalized patients. Recently, we
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. However, it also
requires validation in hospitalized patients. As result, we propose the following and the
following specific aims:

Aim #1: To validate the B-CAM in non-ICU hospitalized patients. The B-CAM will be performed
by a clinical trials associate (CTA) and principal investigator in 150 non-ICU hospitalized
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 non-ICU hospitalized patients. The CAM-ICU will be
performed by a clinical trials associate (CTA) and principal investigator in approximately
150 non-ICU hospitalized 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 non-ICU inpatient setting

- Consulted and evaluated by psychiatry

Exclusion Criteria:

- Severe mental retardation or dementia

- Baseline communication barriers such aphasia, deafness, blindness, or who are unable
to speak English

- Refusal of consent

- Previous enrollment

- Comatose

- Out of hospital before the assessments are completed
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Nashville, Tennessee 27232
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Nashville, Tennessee 37232
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