Two-Step Approach to Delirium Screening

The first step would be to perform a very brief (<20 seconds) delirium assessment that is highly sensitive for delirium to rapidly rule out delirium. This could be performed as part of the initial nursing or triage assessment. Ideally, the highly sensitive delirium screen should have a sensitivity >90% and specificity >50%.

The DTS fulfills these criteria (98% sensitive; 55% specific) and has been validated in older ED patients. Additional details are provided in the next slide. Fick et al observed that using the combination of months of the year backwards and asking “What is the day of the week?” was 93% sensitive and 64% specific for delirium in older hospitalized patients.

• • A negative step 1 screen would rule out delirium and no additional delirium assessment is needed.
  • A positive step 1 screen would trigger a formal and highly specific delirium assessment at the patient’s bedside to rule in delirium.

For the second step of this screening approach, the CAM, bCAM, CAM-ICU, 3D-CAM, or 4AT are examples of more specific delirium assessments that can be used.

This screen could be performed by a trained bedside nurse or treating physician experienced in performing delirium assessments.