Delirium is common, persistent, and independently associated with poor functional recovery 1 month after hip fracture even after adjusting for prefracture frailty. Further research is necessary to identify the mechanisms by which delirium contributes to poor functional recovery, and to determine whether interventions designed to prevent or reduce delirium can improve recovery after hip fracture.

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To determine whether delirium can be diagnosed by telephone, we interviewed 41 subjects aged 65 years or older 1 month after repair of hip fracture, first by telephone and then face-to-face. Interviews included the modified telephone Mini-Mental State Examination and the Delirium Symptom Interview. Delirium was diagnosed using the Confusion Assessment Method diagnostic algorithm, and the telephone results were compared with the face-to-face results (the "gold standard"). Of 41 subjects, 6 were delirious by face-to-face assessment; all 6 were delirious by telephone (sensitivity 1.00). Of 35 patients not delirious by face-to-face assessment, 33 patients were not delirious by telephone (specificity ‫؍‬ 0.94). We conclude that telephone interviews can effectively rule out delirium, but the positive diagnosis should be confirmed by a face-to-face assessment, especially in populations with a low prevalence of delirium. KEY WORDS: delirium; telephone diagnosis; Confusion Assessment Method. J GEN INTERN MED 1998;13:621-623.D elirium is a common problem, affecting 20% to 40% of hospitalized elders. 1 Epidemiologic evidence suggests that a significant proportion of delirious patients require months to return to baseline. 2 As acutely ill patients are increasingly managed in settings other than the hospital, delirium may occur in rehabilitation, skilled nursing, and home care settings. Heretofore, the assessment of delirium has required a face-to-face interview. [3][4][5] This poses a significant logistic challenge for patients in settings other than the hospital. A telephone assessment of delirium would greatly aid research and clinical care, but has not yet been validated. This report presents a validation study comparing a telephone strategy with the "gold standard" of face-to-face interviews.

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