Delirium Severity in the Hospitalized Patient: Time to Pay Attention
Authors: Kathryn J. Eubank, Kenneth E. Covinsky
Journal: Annals of Internal Medicine (2014)

Editorials15 April 2014Delirium Severity in the Hospitalized Patient: Time to Pay AttentionKathryn J. Eubank, MD and Kenneth E. Covinsky, MD, MPHKathryn J. Eubank, MDFrom University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California. and Kenneth E. Covinsky, MD, MPHFrom University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-0553 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Delirium is an acute confusional state characterized by inattention, impaired cognition, psychomotor disturbances, and a waxing and waning course. It is common in hospitalized older adults, ranging in prevalence from 20% to 50% in general medical–surgical units and from 70% to 80% in intensive care units (1).Delirium is a strong predictor of poor patient outcomes. Patients with the condition have increased rates of mortality, cognitive and functional decline, and institutionalization and longer lengths of stay (1, 2). Delirium costs the U.S. health care system more than $150 billion every year (3). Studies show that 30% to 40% of cases ...References1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911-22. [PMID: 23992774] CrossrefMedlineGoogle Scholar2. Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing. 2006;35:350-64. [PMID: 16648149] CrossrefMedlineGoogle Scholar3. Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168:27-32. [PMID: 18195192] CrossrefMedlineGoogle Scholar4. Inouye SK. Delirium in older persons. N Engl J Med. 2006;354:1157-65. [PMID: 16540616] CrossrefMedlineGoogle Scholar5. Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009;5:210-20. [PMID: 19347026] CrossrefMedlineGoogle Scholar6. Inouye SK, Kosar CM, Tommet D, Schmitt EM, Puelle MR, Saczynski JS, et al. The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts. Ann Intern Med. 2014;160:526-33. LinkGoogle Scholar7. Inouye SK, vanDyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113:941-8. [PMID: 2240918] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California.Disclaimer: The opinions expressed are those of the authors and not necessarily those of the funders or the Department of Veterans Affairs.Grant Support: From the Donald W. Reynolds Foundation and the National Institute on Aging, including the UCSF Older Americans Independence Center (P30AG044281) and a MidCareer Research and Mentoring Award (K24AG029812; Dr. Covinsky).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0553.Corresponding Author: Kathryn J. Eubank, MD, 4150 Clement Street, Building 203, Room 1B-77, San Francisco, CA 94121; e-mail, kathryn.[email protected]edu.Current Author Addresses: Drs. Eubank and Covinsky: Division of Geriatrics, University of California, San Francisco, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, Suite 181G, San Francisco, CA 94121. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe CAM-S: Development and Validation of a New Scoring System for Delirium Severity in 2 Cohorts Sharon K. Inouye , Cyrus M. Kosar , Douglas Tommet , Eva M. Schmitt , Margaret R. Puelle , Jane S. Saczynski , Edward R. Marcantonio , and Richard N. Jones The CAM-S: Development and Validation of a New Scoring System for Delirium Severity in 2 Cohorts Sharon K. Inouye , Cyrus M. Kosar , Douglas Tommet , Eva M. Schmitt , Margaret R. Puelle , Jane S. Saczynski , Edward R. Marcantonio , and Richard N. Jones Metrics Cited ByPhenotypes and subphenotypes of delirium: a review of current categorisations and suggestions for progressionThe COVID-19 conundrum: Where both the virus and treatment contribute to deliriumA New Severity Scoring Scale for the 3‐Minute Confusion Assessment Method ( 3D‐CAM )Cognitive Issues in the Older AdultUse of an expert panel to identify domains and indicators of delirium severityAnti‐psychotics for treatment of delirium in hospitalized non‐ICU patients: A Cochrane Review SummaryAssessment of Instruments for Measurement of Delirium SeverityPrognostic effects of delirium motor subtypes in hospitalized older adults: A prospective cohort studyEmergencies in Geriatric PsychiatryDerivation and Validation of a Severity Scoring Method for the 3-Minute Diagnostic Interview for Confusion Assessment Method--Defined DeliriumEmergency Medicine Settings 15 April 2014Volume 160, Issue 8Page: 574-575KeywordsAlgorithmsConsciousnessDeliriumDisclosureElderlyHealth carePatientsResearch facilitiesSleepTroponin ePublished: 15 April 2014 Issue Published: 15 April 2014 CopyrightCopyright © 2014 by American College of Physicians. 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