Choosing a Delirium Screen
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Multiple factors to consider
Who will be performing the delirium assessments and how much training will be available?
- If the training is limited, then consider using a simpler delirium assessment that incorporates objective cognitive testing.
How long do nurses or physicians have to perform the delirium assessment?
- If time is limited, then consider using a briefer delirium assessment.
If time is limited, do you want a more sensitive or a specific delirium assessment?
- If a positive delirium screen will lead to a labor-intensive or expensive intervention, then consider using a delirium assessment with higher specificity.
- If a negative screen will lead to a delirium prevention intervention, then consider using a delirium assessment with higher sensitivity.
What delirium assessment are other clinical settings using?
- It is also important to consider what other clinical settings are using. If the inpatient floors are using the RASS, then it may make more sense to use the RASS in the ED.
Key Point
There is no one-size-fits-all approach to delirium screening, especially in the ED. The decision is even more difficult when validation data are limited. When deciding to choose a delirium assessment, one must consider multiple factors.
Regardless of which delirium assessment is chosen, sacrifices will have to be made. One must balance a delirium assessment’s advantages against its disadvantages.
Abbreviations
ED, emergency department
RASS, Richmond Agitation Sedation Scale