4 An original study deriving a delirium prediction rule following elective surgery identified seven important factors (reported with
adjusted odds ratios): age >70 years (OR 3.3; 95% CI 1.9–5.9), poor cognitive status (OR 4.2; 95% CI 2.4–7.3), poor functional status (OR 2.5; 95% CI 1.2–5.2), self-reported alcohol abuse (OR 3.3; 95% CI 1.4–8.3), markedly abnormal preoperative serum sodium, potassium, or glucose level (OR 3.4; 1.3–8.7), noncardiac thoracic surgery (OR 3.5; 95% CI 1.6–7.4), and aortic aneurysm surgery (OR 8.3; 95% CI 3.6–19.4).25 (see Table 2 Selleckchem LDK378 for a list of postoperative delirium risk factors). Patients with two or more risk factors should be considered at greater risk than patients with zero or one risk factor. In general, the risk for delirium is greater in the emergency setting in comparison to the elective setting. selleck compound Health care professionals caring for postsurgical patients should be trained in the recognition and documentation of signs and symptoms associated with delirium, including hypoactive presentations. The diagnosis of delirium is derived from history-taking (including from informants), examination, and review of medical records, laboratory, and radiologic findings. The hallmark of delirium is acute cognitive change from baseline.26 Common symptoms
of delirium are listed in Table 3. In elective surgery, patients should have preoperative cognitive testing in order to document their baseline27 and 28 (see Appendix 2B, online only, for a list of cognitive screening tools). Clinical suspicion must be high in order to detect delirium in patients following surgery.29 Branched chain aminotransferase Inattention is the cardinal symptom of delirium, and use of a brief cognitive
test is required for accurate diagnosis. The hypoactive delirium subtype is easily overlooked and yet may be associated with the poorest outcomes.30 and 31 All medical personnel need familiarity with the signs and symptoms of delirium.19 A formal delirium diagnosis tool (such as the DSM, ICD-10, or Confusion Assessment Method diagnostic algorithm (see Appendix 2C, online only, for list of delirium diagnosis tools) used by a competent health care professional should be used to make the diagnosis of delirium (see Table 4). When screening a patient for delirium, a health care professional trained in the assessment of delirium should use a validated delirium screening instrument for optimal delirium detection. Numerous studies have demonstrated that nurses and physicians do not accurately diagnosis delirium on the basis of their bedside evaluation, including in the intensive care unit32, 33 and 34 and medical and surgical wards.