Diagnosing delirium by telephone

Abstract

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.

Postoperative Delirium: The Importance of Pain and Pain Management

“…However, this result remains significant even when adjusting for the level of pain. Although differences in patient population may account for the difference in findings compared with that reported by previous studies, our present results suggest that a randomized trial is necessary to further CAM ϭ confusion assessment method; CNS ϭ central nervous system; PCA ϭ patient-controlled analgesia; VAS ϭ verbal version of visual analog scale (0 -10) [linear tool widely used to measure pain from none (0) to severe (10)]. delineate the precise role of a postoperative method for postoperative pain management and postoperative delirium.…”

Risk Factors for Long-Term Brain Dysfunction after Chronic Critical Illness

“…Six months after discharge from the RCU, our research nurse telephoned survivors to administer the validated telephone version of the Confusion Assessment Method (CAM) after a preliminary assessment of the patient's level of consciousness and capacity to respond (16). If a family member or caregiver reported that the patient was too impaired to respond, the nurse used a formal, written protocol to clarify whether the impairment was cognitive and/or physical by asking systematically and in detail whether the patient was (1) too physically weak or otherwise physically impaired to move to, hold, or speak into a phone; or whether (2) the patient was unable to respond to the telephone interview because of an alteration of consciousness (other than normal sleep or ORIGINAL RESEARCH drowsiness), confusion, dementia, or other cognitive impairment.…”

Postoperative Delirium in Elderly Patients after Elective Hip or Knee Arthroplasty Performed under Regional Anesthesia

“…Because of the accuracy, brevity, and ease of use by clinical interviewers, the Confusion Assessment Method (CAM) has become the most widely used standardized delirium instrument for clinical and research purposes over the past 16 years [5]. It has been adopted for use in a variety of settings such as the intensive care unit [2], emergency rooms [8], and at home via telephone surveys [10]. The CAM was developed to allow nonpsychiatrically trained personnel (either clinical or research staff) to quickly and accurately identify patients with delirium.…”