UMEM Educational Pearls

Category: Neurology

Title: Delirium - are we really looking for it?

Keywords: delirium, geriatric, elderly, pitfall (PubMed Search)

Posted: 12/25/2014 by Danya Khoujah, MBBS
Click here to contact Danya Khoujah, MBBS

Delirium has long been recognized as a common disorder of the geriatric ED population (seen in up to 20% of patients above the age of 65 years), but how good are we at detecting it?

Studies show that the diagnosis of delirium is made in the ED in only 11-46% of patients, which means that more than half go undiagnosed. The problem is, the risk of death at 3 months increases by 11% for every 48 hours of delirium the patient experiences, and so does their length of stay and functional decline. It is mostly missed in patients who have a baseline cognitive dysfunction, such as dementia.

So what can we do about that?

Treat delirium as a neurolgical emergency; be vigilant about diagnosing it and treating it. There are a lot of neurocognitive tests that can be used for diagnosis (such as the mini-mental status exam), but they are usually too cumbersome to use in an ED setting. The CAM (Confusion Assessment Method) has been extensively studied and has a sensitivity and specifity of about 95% to diagnose delirium. It includes the acuity of onset, fluctuant course, inattention (the hallmark), disorganized thinking and/or altered level of consciousness.

Bottom Line? Don't forget to screen your elderly patients for delirium and treat them accordingly!


1. Wilber ST, Han JH. Altered Mental Status in the Elderly. Geriatric Emergency Medicine Principles and Practice. Edited by Kahn JH, Maguaran Jr BG, Olshaker JS. New York: Cambridge University Press; 2014: 102-113

2. Barron EA, Holmes J. Delirium within the emergency Care setting, occurence and detection: a systematic review. EMJ 2013; 30(4) 263-268

3. Wei LA, BA, Fearing MA et al. The Confusion Assessment Method: A Systematic Review of Current Usage J Am Geriatr Soc 56:823 830, 2008