Current Trends for Delirium Screening within the Emergency Department

Abstract

Delirium is an acute neurological disorder that involves attention and cognition. It is associated with a high risk of morbidity and mortality among older people (>65 years old). In the context of the Emergency Department (ED), it is frequently experienced by patients but often not recognized. Literature studies have identified some screening instruments for an initial evaluation of delirium. Most of these tools have not been validated yet in the context of emergencies, but, in other settings, they were very useful for assessing and maximizing the recognition of this condition among older patients. We conducted a review of the literature, including randomized control trials, clinical and observational studies, and research studies published in recent years, confirming that most of the screening tools for delirium used in the intensive care unit (ICU) or the geriatric department have not been tested in the ED, and the ideal timing and form of the delirium assessment process for older adults have not been defined yet. The aim of our review is to summarize the updated evidence about the screening tools for delirium in the context of the ED, due to the fact that overcrowding of the ED and the stressful condition of emergency situations (that contribute to the onset of delirium) could expose older patients to a high risk of complications and mortality if delirium is not promptly recognized. In conclusion, we support the evidence that delirium is a current and real condition that emergency physicians have to face daily, and we are aware that more research is needed to explore this field in order to improve the overall outcomes of older patients admitted to the ED.

A Lethal Combination of Delirium and Overcrowding in the Emergency Department

“…They may be prone to fall, remove intravenous catheters or endotracheal tubes, exhibit intolerance to invasive procedures, or become aggressive, thus endangering themselves and those providing care [7,8]. Despite the high morbidity and mortality associated with delirium, emergency healthcare providers underrecognized it [9][10][11]. The difficulty in recognizing delirium begins at triage, even with advanced systems that best adapt to the increasing complexity of older patients and the rise in crowding [12,13].…”

The 4AT scale for rapid detection of delirium in emergency department triage

“…The most tools used are the 4 “A”s Test (4AT), Confusion Assessment Method (CAM), Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), Brief Confusion Assessment Method (bCAM), 3-Minute Diagnostic Confusion Assessment Method (3D-CAM) and, Spatial Span Forwards (SSF), Clock Drawing Test (CDT) and Delirium Triage Screen (DTS). The common characteristic is that they are quick screening scales, generally requiring less than 3 min, suitable to be performed in the ED ( 15 ). Early detection and intervention in people with delirium is a strong indicator of the quality of hospital care for vulnerable patients ( 16 , 17 ).…”