Informant based questionnaire I-AGeD tool to improve poor recognition of delirium in emergency room.

Jos van Campen, Geriatrician,

Other Contributors:

September 06, 2013

Dear Madame, Sir,

In their interesting study Suffoletto et al [1] examined delirium recognition by emergency physicians. Trained researchers identified delirium in 24/259 (9%) of emergency room older patients. Diagnosis was based on CAM -ICU criteria, Richmond Agitation and Sedation scale and an interview with the surrogate. By contrast, emergency physicians recognised delirium in only 8/24 cases and misidentified delirium in seven cases. Delirium is a serious condition, and it is associated with poor outcome. Recognition of delirium is important and might improve patient outcomes. Study findings are in line with previous studies that showed there is room for improving delirium recognition,

We have looked at this problem recently and developed and validated a new screening instrument, the Informant Assessment of Geriatric Delirium scale (I-AGeD) [2]. It is a 10 items caregiver baser questionnaire. The I- AGeD was validated in elderly patients admitted to a geriatric wards of two general hospitals. Average age in the construction cohort was 86,4 yr, 51/88 suffered from dementia and delirium was found in 31/88. In two validation cohorts, sensitivity and specificity ranged from 70-88.9% and 66.7 -100%.

Given the present demographics, the incidence of delirium will rise, and recognition of delirium may be difficult, especially in patients with dementia. Training physicians outside the field of geriatrics on this issue is important. We think that an caregiver based screening instrument might be an efficient way to improve early and fast recognition of delirium in geriatric patients.

With kind regards,

JPCM van Campen1, HFM Rhodius Meester1, JFM de Jonghe2

1 Slotervaart hospital, department of geriatric medicine, Amsterdam, the Netherlands 2 Medical Center Alkmaar, department of geriatric medicine, Alkmaar, the Netherlands

References

1 Brian Suffoletto, Thomas Miller, Adam Frisch, Clifton Callaway, Emergency physician recognition of delirium, Postgrad Med J 2013 June, ahead of Print

2 Rhodius- Meester HFM, van Campen JPCM, Wung W, Meagher DM et al, Development and validation of the Informant Assessment of Geriatric Delirium Scale (I-AGeD). Recognition of delirium in geriatric patients. EGM , 2013; 4(2):73-7

Conflict of Interest:

None declared

Conflict of Interest

None declared