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November 17, 2010

Diagnosing Delirium

JAMA. 2010;304(19):2124-2127. doi:10.1001/jama.2010.1616

To the Editor: Dr Wong and colleagues1 provided a systematic review that included discussion of easy-to-use bedside instruments to detect delirium; such tools are paramount in early diagnosis and treatment. However, there are 2 important additional aspects that we would like to address.

Delirium as a term for acute cerebral dysfunction falls short when perceived as a binary phenomenon with the only options of present or completely absent. This approach will arbitrarily generate a cutoff on a continuous or ordinal range of dysfunction. For either conservative or interventional measures, early detection of delirium—even at predelirium or subsyndromal levels—is of great importance. Similar to pain, delirium presents in degrees better represented on an ordinal scale (eg, 0-10) than represented simply as yes or no. As with pain, evolving delirium should alert physicians to look for underlying possible causes and opens the possibility of treatment before reaching a critical value. With respect to outcomes, the severity as well as the length of delirium symptoms matters.2 Additionally, patients with subsyndromal delirium are at an increased risk of adverse outcomes.3

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