Early detection of delirium – using the CAM score

Resumé

Background: Delirium is common in elderly patients and has been identified as an independent marker for increased mortality and hospital-acquired complications, yet it is poorly recognized by health care providers. The aim of this study was to investigate whether systematic use of the validated screening tool Confusion Assessment Method (CAM) would result in a higher recognizing of delirium in patients ≥ 65 years old admitted at Odense Emergency Department (FAM).

Methods: All caregivers in the Emergency department (ED) at Odense University Hospital received 2 hours of education in delirium and how to use the CAM score. They were asked to systematically perform CAM score in all patients ≥ 65 years at arrival to the ED and at least every 8 hours.  During 2 periods of 5 days - one before the caregivers was educated (pre-CAM) and one 4 weeks after CAM scoring was started (during-CAM). A research team interviewed all ≥ 65 year old patients and their caregivers at the first and second day of admission. In relation to the interviews all patients underwent a cognitive assessment using the CAM by a trained investigator. These results were blinded to the clinical personal. After discharge patient files were screened with the aim to identify any delirium registered by the clinical personal.

Results: Out of 276 screened patients 192 where included in the project. 100 patients and were included in the pre-CAM group and 92 patients in the during-CAM group. According to the registrations by the research team 24 of 100 (24% 95%CI 16%-34%) patients experience delirium in the pre-CAM group and 18 of 92 (20% 95%CI 12%-29%) in the during-CAM group. Increasing age and comorbidity was related to delirium.  Prevalence of the diagnoses delirium registered in the patient file increased from 1 of 24 (4% 95%CI  0%-21%) to 9 of 18 (50% 95%CI 26%-74%).

Conclusion: One out of four elderly acute patients has deliria symptoms during the first 2 days at hospital. Systematic CAM scoring does not change the prevalence but increase the awareness significantly. The high prevalence underlines the clinical importance of the problem.