title: Exploring the utility of ultra-brief delirium assessments in a nonintensive care geriatric population: the GEM study.
abstract: OBJECTIVE
  To determine how an ultra-brief structured tool that would require usually less than a minute for delirium assessment compares with a clinical assessment based on Diagnostic and Statistical Manual-IV (DSM-IV) in a geriatric postacute care (PAC) rehabilitation unit.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Postacute geriatric hospital ward of a Veteran's Affairs hospital.
  
  
  METHODS
  Consecutively admitted patients between 50 and 100 years old for inpatient postacute medical care.
  
  
  METHODS
  Two teams, blinded to one another's evaluations, performed daily delirium assessments using either the Confusion Assessment Method for the intensive care unit (CAM-ICU) or clinical assessment based on DSM-IV.
  
  
  RESULTS
  There were 61 patients enrolled (median 73 years old, range: 52-94), who underwent 521 paired observations. Delirium was detected in 18 patients (29.5%) by one of the two screening methods over the course of the study, most of whom (14 patients, 23%) were delirious on the first day of enrollment. Delirium was identified by the CAM-ICU on 12.6% of the observations and by the clinical assessment on 6% of the observations (κ = 0.25, 95% confidence interval [CI]: 0.09, 0.40). Examination of disagreement between the 2 evaluations revealed that patients with dementia (κ = 0.11, 95% CI: -0.14, 0.27) had 10.7 times higher odds (95% CI: [3.1, 36.8], p value < .001) of having discordance than patients without dementia.
  
  
  CONCLUSIONS
  Different delirium assessments may disagree depending on the study population. Dementia patients are especially challenging to evaluate for delirium.
authors.affiliation: *Address correspondence to James S. Powers, Department of Medicine, Vanderbilt University, 7155 Vanderbilt Medical Center East, Nashville, TN 37232. E-mail: james.powers@vanderbilt.edu.
authors.forename: James S
authors.initials: JS
authors.lastname: Powers
authors.forename: Tracey
authors.initials: T
authors.lastname: Doering
authors.forename: Sharon
authors.initials: S
authors.lastname: Gordon
authors.forename: Svetlana K
authors.initials: SK
authors.lastname: Eden
authors.forename: Ayumi
authors.initials: A
authors.lastname: Shintani
authors.forename: John
authors.initials: J
authors.lastname: Schnelle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011446:Prospective Studies; D011594:Psychometrics / Q000379:methods*