The Language of Delirium: Keywords for Identifying Delirium from Medical Records

Abstract

Background Electronic medical records (EMRs) offer the potential opportunity to streamline the search for patients with possible delirium. However, the identification of key words is a necessary first step in the effective and systematic use of EMRs for both clinical and research purposes. Objective To identify words and phrases commonly noted in charts of patients with delirium. Design, Setting, and Participants Participants were 67 patients aged 70+ undergoing major elective surgery with evidence of confusion in their medical charts nested within a cohort study of 300 patients. We report the rate of common words and phrases associated with symptoms of delirium and report positive predictive value compared with a reference standard delirium diagnosis. Results Eight key words or phrases (altered mental status, delirium, disoriented, hallucination, confusion, reorient, disorient and encephalopathy) had positive predictive values (PPVs) of 60–100% for diagnosis of delirium. Key words were charted more often in nursing notes compared with physician notes. For example, in patients with delirium, nursing notes had an average of 6.4 notes containing a one of the 8 key words for delirium compared with an average of 2.8 in physician charts. Conclusions A brief list of key words or phrases may serve as building blocks for a methodology to screen for possible delirium from charts and large databases for research and real-time clinical decision making.

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