Delirium Assessment

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Assessment of Delirium:
In the true sense, Delirium assessment is actually part of the overall consciousness assessment. 4 It is evident from the review that development of instruments for assessment of delirium has moved far beyond just screening patients for delirium. 21 Most of the instruments have been designed based on the DSM criteria. 21 Scales for assessment of delirium in clinical and research setting are: 22
A. Instruments for assessment of arousability of the patient: RASS.
B. Instruments for screening for premorbid cognitive disturbances: IQCODE.
C. Screening instruments: NEECHAM Confusion Scale, Nursing Delirium Screening Scale, Delirium Observation Screening Scale, ICDSC, Pediatric Anesthesia Emergence Delirium scale, Global
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Sharon Inouye to assess delirium at bedside. 4 The best supportive data available for CAM as a bed side diagnostic scale. The CAM assesses the presence, severity, and fluctuation of 9 delirium features: Acute onset, inattention, disorganized thinking, altered level of consciousness, disorientation, memory impairment, perceptual disturbances, psychomotor agitation or retardation, altered sleep-wake cycle.
It can be administered in 5 min by non-psychiatrist physicians. 4, 22 The CAM diagnostic algorithms based on cardinal elsements of the DSM-III R criteria for delirium. 22 The validity of CAM has been evaluated against the diagnosis made by geriatrician, psychiatrist, neuropsychologist and advanced practice nurses; DSM-III, DSM-III R, DSM-IV or ICD-10 criteria or consensus diagnosis. The sensitivity of CAM has varied from 46% to 100% with lower sensitivities reported when CAM was used by nurses or research assistants. 23-25 The specificity of CAM has varied from 63% to 100%, with lower specificity in presence of psychiatric comorbidity. 41 It is one the very few instruments which have been translated in 10 languages and has been widely used in research. 22, 24 One Indian study observed that the CAM is a useful screening method with high sensitivity for diagnosis of delirium at the bedside.

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