The Effect of Multiple Assessments on Delirium Detection: a Pilot Study*

  • SA. de Freitas McMaster University, Hamilton, Joseph Brant Hospital Corporation
  • EKC. Wong University of Toronto, Hamilton Health Sciences/McMaster University
  • JY. Lee McMaster University
  • C. Reppas-Rindlisbacher University of Toronto
  • C. Gabor Hamilton Health Sciences Corporation
  • A. Curkovic Hamilton Health Sciences Corporation
  • CJ. Patterson McMaster University, Hamilton Health Sciences/McMaster University
Keywords: Delirium, 3D-CAM, orthopedic, point-prevalence, multiple observations

Abstract

Background

Delirium is characterized by fluctuating attention or arousal, with high prevalence in the orthopaedic ward. Our aim was to: 1) establish the prevalence of delirium on an orthopaedic ward, and 2) compare delirium prevalence using a single geriatrician assessment vs. multiple 3D-CAM (3-Minute Diagnostic Interview for Confusion Assessment Method) assessments during the day. We hypothesized that multiple assessments would increase the detection rate due to the fluctuating nature of delirium.

Methods

Comparative study conducted at an academic hospital in Hamilton, Ontario. Participants included patients 65 years and older admitted to the orthopaedic ward (n=55). After a geriatrician made the first assessment of delirium by 3D-CAM on each patient, teams with specialized geriatrics training re-assessed participants up to four times. Delirium rates based on first assessment were compared to cumulative end-of-day rates to determine if detection increased with multiple assessments.

Results

The prevalence of delirium was 30.9% (17 participants) us­ing multiple assessments. Of these cases, 13 (76.4%) were detected in the initial geriatrician assessment. In patients with hip fractures, 70.6% (12 of 17) were identified as delirious by multiple assessments.

Conclusion

As symptoms fluctuate, multiple daily CAM assessments may increase the identification of delirium in orthopaedic inpatients.

Author Biographies

SA. de Freitas, McMaster University, Hamilton, Joseph Brant Hospital Corporation

Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton Health Sciences Corporation

EKC. Wong, University of Toronto, Hamilton Health Sciences/McMaster University

Department of Medicine, Faculty of Medicine, Geriatric Education and Research in Aging Sciences (GERAS) Centre,

JY. Lee, McMaster University

Department of Medicine, Faculty of Health Sciences, Geriatric Education and Research in Aging Sciences (GERAS) Centre, Hamilton Health Sciences/McMaster University

C. Reppas-Rindlisbacher, University of Toronto

Department of Medicine, Faculty of Medicine

CJ. Patterson, McMaster University, Hamilton Health Sciences/McMaster University

Department of Medicine, Faculty of Health Sciences, , Hamilton; Hamilton Health Sciences Corporation, Geriatric Education and Research in Aging Sciences (GERAS) Centre

Published
2020-11-23
How to Cite
de Freitas, S., Wong, E., Lee, J., Reppas-Rindlisbacher, C., Gabor, C., Curkovic, A., & Patterson, C. (2020). The Effect of Multiple Assessments on Delirium Detection: a Pilot Study*. Canadian Geriatrics Journal, 23(4), 277-282. https://doi.org/10.5770/cgj.23.433
Section
Original Research